Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 121 | TX |
N | 222Z00000X | Podiatrist | 121 | TX |
Y | 224P00000X | Prosthetist | 121 | TX |
NPI | 1265792089 |
---|---|
Provider Name | Phyllis F. Mcniel |
First Address | Gainesville, TX 76240-4281 |
Second Address | Gainesville, TX 76240-4281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2012 |
Last Update Date | 26/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
121 | TEXAS BOARD OF ORTHOTICS/PROSTHETICS (01) | TX |