Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 719082 | TX |
NPI | 1043322696 |
---|---|
Provider Name | Mrs. Michelle R Dehan |
First Address | Texarkana, TX 75503-4657 |
Second Address | Texarkana, TX 75503-4657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 14/02/2012 |