Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 627945 | TX |
N | 363LN0000X | Nurse Practitioner - Neonatal | 627945 | TX |
NPI | 1063781045 |
---|---|
Provider Name | Sandra O'pry |
First Address | Sunrise, FL 33323-2853 |
Second Address | Arlington, TX 76015-2908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2011 |
Last Update Date | 21/12/2011 |