| NPI | 1750170809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA MANGON Owner 832-334-8427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-07-11 |