Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP127539 | TX |
NPI | 1053708693 |
---|---|
Provider Name | Tammie Michael |
First Address | Galveston, TX 77555-0177 |
Second Address | Galveston, TX 77555-0177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 21/04/2015 |