| NPI | 1952604894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY FAYE SELF Director 903-563-4765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WL0100X Registered Nurse, Lactation Consultant (Licence: TX 11291501) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 163WM0102X Registered Nurse, Maternal Newborn (Licence: TX 716125) | |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2012-11-06 |