Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 1017433 | TX |
NPI | 1013668508 |
---|---|
Provider Name | Mrs. Kobra Namdari Gurmendi |
First Address | Heath, TX 75032-7750 |
Second Address | Heath, TX 75032-7750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2022 |
Last Update Date | 16/01/2022 |