Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 363LP0200X | Nurse Practitioner | Pediatrics | | | No |
| 2 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | | | No |
| 3 | 2080P0208X | Pediatrics | Pediatric Infectious Diseases | | | No |
| 4 | 2080P0206X | Pediatrics | Pediatric Gastroenterology | | | No |
| 5 | 2080P0205X | Pediatrics | Pediatric Endocrinology | | | No |
| 6 | 2080P0216X | Pediatrics | Pediatric Rheumatology | | | No |
| 7 | 2080P0201X | Pediatrics | Pediatric Allergy/Immunology | | | No |
| 8 | 2080P0210X | Pediatrics | Pediatric Nephrology | | | No |
| 9 | 207YP0228X | Otolaryngology | Pediatric Otolaryngology | | | No |
| 10 | 2080P0214X | Pediatrics | Pediatric Pulmonology | | | No |
| 11 | 208000000X | Pediatrics | | | | Yes |