Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP 125748 | TX |
NPI | 1154405553 |
---|---|
Provider Name | Patricia Walls |
First Address | Spring Branch, TX 78070-5951 |
Second Address | San Antonio, TX 78229-3539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 01/05/2017 |