Provider Demographics
NPI:1982994059
Name:TAWATER, KRISTINE (LM)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:TAWATER
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 AMERICAS CUP
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2626
Mailing Address - Country:US
Mailing Address - Phone:214-914-5015
Mailing Address - Fax:
Practice Address - Street 1:8201 AMERICAS CUP
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-2626
Practice Address - Country:US
Practice Address - Phone:214-914-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99149176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife