Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99081 | TX |
NPI | 1063643278 |
---|---|
Provider Name | Mrs. Matsayah S. Shalom |
First Address | Leesburg, TX 75451-4008 |
Second Address | Leesburg, TX 75451-4008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 05/08/2009 |