Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 53-79082-062 | KS |
NPI | 1083244123 |
---|---|
Provider Name | Reyna Silvia Aguilar-Martinez |
First Address | Liberal, KS 67901-2784 |
Second Address | Liberal, KS 67901-2784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2020 |
Last Update Date | 16/01/2020 |