Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2206 | TX |
NPI | 1235482449 |
---|---|
Provider Name | Ms. Trista Suzanne Davis |
First Address | San Antonio, TX 78204-1951 |
Second Address | San Antonio, TX 78204-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2012 |
Last Update Date | 08/05/2013 |