Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 520285 | TX |
NPI | 1235189598 |
---|---|
Provider Name | Ms. Yvonne Riddle |
First Address | Fort Worth, TX 76123-2066 |
Second Address | Fort Worth, TX 76104-2122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |