Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP141320 | TX |
NPI | 1043781701 |
---|---|
Provider Name | Mrs. Lisa Vercellino Salazar |
First Address | Houston, TX 77084-3277 |
Second Address | Houston, TX 77054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 15/05/2019 |