Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP131041 | TX |
NPI | 1043742315 |
---|---|
Provider Name | Thea Marie Barber Cordero |
First Address | Cypress, TX 77429-8613 |
Second Address | Cypress, TX 77429-8239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 28/03/2017 |