Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 674034 | TX |
NPI | 1013923051 |
---|---|
Provider Name | Ms. Gina Marie Harris |
First Address | Kyle, TX 78640-9224 |
Second Address | Austin, TX 78701-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |