Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1114525029 |
---|---|
Provider Name | Tricia Carlisle |
First Address | Austin, TX 78749-3926 |
Second Address | Austin, TX 78745-5286 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2020 |
Last Update Date | 20/10/2020 |