NPI age
20 years
Enumerated 2005-08-10
Across 22123 active nurse practitioner providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 602063 | BLUE CROSS/BLUE SHEILD TX |
| 01 (TX) | 752328635 | TAX ID# |
| 01 (TX) | 5679361 | AETNA |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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