Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 256222 | TX |
NPI | 1003996364 |
---|---|
Provider Name | Ruth Herring |
First Address | Dallas, TX 75235-7701 |
Second Address | Dallas, TX 75235-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 21/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141162101 | (05) | TX |
P26051 | (02) |