Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP121002 | TX |
NPI | 1083981021 |
---|---|
Provider Name | Stacey Cole |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75235-7709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2011 |
Last Update Date | 01/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
323879203 | (05) | TX |