Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 131241 | TX |
NPI | 1083065726 |
---|---|
Provider Name | Mrs. Yvette Therese Surrell |
First Address | Tomball, TX 77375-7508 |
Second Address | Huntsville, TX 77340-4905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 23/06/2016 |