Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 707057 | TX |
NPI | 1003167982 |
---|---|
Provider Name | Susan C. Chesire |
First Address | Dallas, TX 75246-1800 |
Second Address | Dallas, TX 75246-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2012 |
Last Update Date | 29/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
307523601 | (05) | TX |