Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 1034154 | TX |
NPI | 1043972789 |
---|---|
Provider Name | Ms. Medra M Blevins |
First Address | Dallas, TX 75390-9134 |
Second Address | Dallas, TX 75390-9134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2021 |
Last Update Date | 02/11/2021 |