Healthcare Provider Details

I. General information

NPI: 1164087417
Provider Name (Legal Business Name): TOMOKO HATTORI CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 RR 620 N STE 101
AUSTIN TX
78750-1141
US

IV. Provider business mailing address

12701 RR 620 N STE 101
AUSTIN TX
78750-1141
US

V. Phone/Fax

Practice location:
  • Phone: 512-593-6022
  • Fax: 512-593-9130
Mailing address:
  • Phone: 512-593-6022
  • Fax: 512-593-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAP139857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: