Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 3845-33 | WI |
N | 363L00000X | Nurse Practitioner | 859245 | TX |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3845-33 | WI |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP125462 | TX |
NPI | 1033443700 |
---|---|
Provider Name | Yan Cao |
First Address | Tyler, TX 75702-7747 |
Second Address | Canton, TX 75103-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2009 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
333052403 | (05) | TX |