Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 675784 | TX |
NPI | 1013347210 |
---|---|
Provider Name | Mrs. Elisa Dang |
First Address | Houston, TX 77081-4771 |
Second Address | Houston, TX 77081-4771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 25/11/2013 |