# TANPRASERTH VATANADILOK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1326071838
- **Gender:** Man
- **Credential:** N.P.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 611125 | TX | Yes |

## Other

- **Enumeration date:** 07/08/2006
- **Last updated:** 10/18/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 170306808 | WELLMED MEDICAID | TX |
| 01 | — | TXB158725 | WELLMED MEDICARE | TX |