Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | TX543969 | TX |
NPI | 1023140712 |
---|---|
Provider Name | Ms. Patrice Ann Leger-Nicholson |
First Address | Dallas, TX 75235-7708 |
Second Address | Dallas, TX 75231-4534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 31/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149426201 | TPI (01) | TX |