Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1023526 | TX |
NPI | 1003406489 |
---|---|
Provider Name | Prof. Beena Susan Mathew |
First Address | Dallas, TX 75390-7202 |
Second Address | Dallas, TX 75390-7202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2021 |
Last Update Date | 20/01/2021 |