Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP126352 | TX |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP126352 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP126352 | TX |
NPI | 1033510979 |
---|---|
Provider Name | Mrs. Lorraine Victorian-Burks |
First Address | Dallas, TX 75215-2309 |
Second Address | Dallas, TX 75215-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 07/10/2021 |