Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP136468 | TX |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP136468 | TX |
NPI | 1245716174 |
---|---|
Provider Name | Serena Stansbury |
First Address | Fort Worth, TX 76244-7699 |
Second Address | Corpus Christi, TX 78414-4100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2018 |
Last Update Date | 13/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14369220 | DL # (01) | TX |