Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 696817 | TX |
NPI | 1033429212 |
---|---|
Provider Name | Sandra Hernandez |
First Address | Amarillo, TX 79106-2512 |
Second Address | Amarillo, TX 79106-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2010 |
Last Update Date | 07/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
217391601 | (05) | TX |