| NPI | 1558165803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA MANGON Owner 832-334-8427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-07-11 |