Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 506272 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 506272 | TX |
NPI | 1104880053 |
---|---|
Provider Name | Mrs. Marilyn Elizabeth Niblock |
First Address | Georgetown, TX 78633-4344 |
Second Address | Georgetown, TX 78633-4344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2006 |
Last Update Date | 11/07/2007 |