Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 462342 | TX |
NPI | 1033143094 |
---|---|
Provider Name | Virginia Mazelin |
First Address | San Antonio, TX 78229-3641 |
Second Address | San Antonio, TX 78229-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |