Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 254904 | TX |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 254904 | TX |
NPI | 1043371149 |
---|---|
Provider Name | Patricia Ann Korenek |
First Address | Galveston, TX 77555-5302 |
Second Address | Angleton, TX 77515-3955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 02/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141146405 | (05) | TX |
P24225 | (02) | TX |