Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 51010179876 | MI |
NPI | 1033424932 |
---|---|
Provider Name | Nikki Shandell Fox |
First Address | Fort Worth, TX 76179-4555 |
Second Address | Ft Worth, TX 76179-4555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 27/09/2021 |