Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP106264 | TX |
NPI | 1003319401 |
---|---|
Provider Name | Ms. Maryjane Keller |
First Address | Houston, TX 77030-3004 |
Second Address | Houston, TX 77030-3004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 12/03/2018 |