Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 240712 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 240712 | TX |
NPI | 1013087501 |
---|---|
Provider Name | Prof. Cynthia A O'harren |
First Address | Fort Worth, TX 76104-8517 |
Second Address | Fort Worth, TX 76104-8517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 15/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P80952 | (02) | TX |