| NPI | 1447822887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEDA EDWARDS-LABOME Credentialing/Billing Manager 832-398-2707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |