Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-42879 | KS |
NPI | 1003300856 |
---|---|
Provider Name | Teresa Lynette Nunez |
First Address | Salina, KS 67401-4144 |
Second Address | Salina, KS 67401-4144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201218570B | (05) | KS |