| NPI | 1790950087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY CONSOLATO Operations Manager 877-800-4882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 0001154175) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 582114) |
| 363LW0102X Nurse Practitioner, Women's Health (Licence: TX 226308) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 774901) | |
| 363L00000X Nurse Practitioner (Licence: TX 750872) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-05-22 |