Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 104785366 | TX |
NPI | 1346804705 |
---|---|
Provider Name | Tory Kalb |
First Address | Austin, TX 78705-1006 |
Second Address | Austin, TX 78705-1006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2019 |
Last Update Date | 13/08/2019 |