Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP132810 | TX |
NPI | 1073058426 |
---|---|
Provider Name | Rachel Fails |
First Address | Galveston, TX 77555 |
Second Address | Galveston, TX 77555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2016 |
Last Update Date | 21/12/2016 |