Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 449277 | TX |
NPI | 1063940369 |
---|---|
Provider Name | Mrs. Ruth Smith |
First Address | Prairie View, TX 77446 |
Second Address | Prairie View, TX 77446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 31/05/2017 |