Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP109956 | TX |
NPI | 1194179598 |
---|---|
Provider Name | Suzan Lanore Timbs |
First Address | Corpus Christi, TX 78412-4913 |
Second Address | Corpus Christi, TX 78412-4913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2016 |
Last Update Date | 21/04/2016 |