MEDICARE: LAURA CHRISTINA HOUILLION CPNP, RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	AP143887	TX

General Provider Information

NPI Number	:	1902344500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA CHRISTINA HOUILLION CPNP, RN, BSN

Provider Business Mailing Address
First Line	:	14100 SAN PEDRO AVE STE 412
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2009
Country	:	US
Telephone Number	:	210-281-8669
Fax Number	:	210-314-5044

Provider Business Practice Location Address
First Line	:	6520 N PRESIDENT GEORGE BUSH HWY STE 100
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-3925
Country	:	US
Telephone Number	:	972-532-9967
Fax Number	:	210-314-5044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	07/26/2021

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