Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | H3194 | TX |
N | 208D00000X | General Practice Physician | 27342-20 | WI |
NPI | 1902919806 |
---|---|
Provider Name | Ms. Valerie H Van Wormer |
First Address | Temple, TX 76504-7451 |
Second Address | Temple, TX 76504-7451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 17/08/2021 |