Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 104388611 | TX |
NPI | 1134897861 |
---|---|
Provider Name | Mrs. Faleigh Ann Agonis |
First Address | San Antonio, TX 78229-3561 |
Second Address | San Antonio, TX 78229-3561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2021 |
Last Update Date | 30/08/2021 |