Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 534124 | TX |
NPI | 1093197865 |
---|---|
Provider Name | Mrs. Debbie Lea Roso |
First Address | Grapevine, TX 76051-3585 |
Second Address | Grapevine, TX 76051-3585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 29/06/2015 |