Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 780351 | TX |
NPI | 1043600489 |
---|---|
Provider Name | Shayna Dae Bauman |
First Address | Fort Worth, TX 76104-2122 |
Second Address | Fort Worth, TX 76104-2122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2015 |
Last Update Date | 23/01/2015 |