Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 692845 | TX |
NPI | 1003168857 |
---|---|
Provider Name | Mrs. Larah Brown |
First Address | Dallas, TX 75390-9055 |
Second Address | Dallas, TX 75390-8809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2012 |
Last Update Date | 14/05/2014 |