Healthcare Provider Details

I. General information

NPI: 1770079923
Provider Name (Legal Business Name): USHA MANANDHAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 RR 620 S STE 102
BEE CAVE TX
78738-7178
US

IV. Provider business mailing address

13830 SAWYER RANCH RD STE 102
DRIPPING SPRINGS TX
78620-5514
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4009
  • Fax: 512-901-3909
Mailing address:
  • Phone: 512-301-6400
  • Fax: 123-016-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138170
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: