Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 685767 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | 685767 | TX |
NPI | 1093021404 |
---|---|
Provider Name | Mrs. Ivette Jones |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78207-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2010 |
Last Update Date | 16/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
297853801 | (05) | TX |
297853802 | CSHCN (01) | TX |