Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME140643 | FL |
Y | 207ND0900X | Dermatopathologist | T0424 | TX |
NPI | 1134515752 |
---|---|
Provider Name | Nicole Reusser Bender |
First Address | Houston, TX 77092-8703 |
Second Address | Houston, TX 77092-8703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 17/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103744900 | (05) | FL |