Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1029371 | TX |
NPI | 1629613070 |
---|---|
Provider Name | Rebecca Mcclay |
First Address | Midland, TX 79703-4817 |
Second Address | Midland, TX 79701-5846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2019 |
Last Update Date | 16/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029371 | STATE LICENSE (01) | TX |