Healthcare Provider Details

I. General information

NPI: 1669959409
Provider Name (Legal Business Name): DAMALIE NAKATE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W SEMANDS ST
CONROE TX
77301-1867
US

IV. Provider business mailing address

10515 PAVONIA DR
HOUSTON TX
77095-5445
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-5598
  • Fax: 936-756-5974
Mailing address:
  • Phone: 281-704-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number774856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: