Individual
AE S OH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1903 CORNELL DR, RICHARDSON, TX 75081-3230
(972) 699-9454
Mailing address
1903 CORNELL DR, RICHARDSON, TX 75081-3230
(972) 699-9454
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
553003
TX
Other
Enumeration date
08/08/2011
Last updated
08/08/2011
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