Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 1059130 | TX |
NPI | 1194483370 |
---|---|
Provider Name | Mrs. Rosemary Kakayor Iyere |
First Address | Beaumont, TX 77713-8201 |
Second Address | Round Rock, TX 78665-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2021 |
Last Update Date | 03/12/2021 |