Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 666063 | TX |
NPI | 1003054735 |
---|---|
Provider Name | Valerie Maclaurin |
First Address | Austin, TX 78723-3078 |
Second Address | Austin, TX 78723-2558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2009 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203314403 | (05) | TX |