Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP140974 | TX |
NPI | 1184183659 |
---|---|
Provider Name | Mrs. Enedelia Reyna |
First Address | Mission, TX 78572-3001 |
Second Address | Mcallen, TX 78503-1251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 14/03/2019 |