Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 578005 | TX |
NPI | 1033313432 |
---|---|
Provider Name | Ms. Mina - Mohammadi |
First Address | Dallas, TX 75204-5879 |
Second Address | Dallas, TX 75216-7167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 08/07/2007 |