Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 577262 | TX |
NPI | 1063693190 |
---|---|
Provider Name | Traci Erin Corder |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75235-5228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 16/11/2007 |