Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Aug 14, 2007
License(s)
RN0000158152 (TN), 785190 (TX), 5006200 (NC), AP119934 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 1239 | Troy, MI 48099-1239 | 336-687-2835 |
| LOCATION | 1301 W 7TH ST STE 121 | Fort Worth, TX 76102-2651 | 817-348-0425 |
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