Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | T0384 | TX |
NPI | 1053775171 |
---|---|
Provider Name | Samantha Caroline Ward Nealon |
First Address | Dallas, TX 75390-9087 |
Second Address | Dallas, TX 75390-3438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 06/07/2021 |