Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP133977 | TX |
NPI | 1073037354 |
---|---|
Provider Name | Ms. Pamela Pena |
First Address | Pharr, TX 78577-1614 |
Second Address | Mcallen, TX 78504-4681 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2017 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP133977 | LICENSE (01) | TX |