Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP133730 | TX |
NPI | 1124563036 |
---|---|
Provider Name | Mrs. Desiree Mcdonald |
First Address | Fort Worth, TX 76104-4110 |
Second Address | Fort Worth, TX 76135-5395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2016 |
Last Update Date | 17/01/2019 |