Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP133719 | TX |
NPI | 1023541448 |
---|---|
Provider Name | Mrs. Jennifer Shah |
First Address | Plano, TX 75025-3027 |
Second Address | Prosper, TX 75078-8876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 03/02/2020 |