Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 424154 | TX |
NPI | 1023119492 |
---|---|
Provider Name | Mrs. Paula Jean Dimmitt |
First Address | Mesquite, TX 75150-1123 |
Second Address | Dallas, TX 75235-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 15/08/2008 |