Healthcare Provider Details

I. General information

NPI: 1598050924
Provider Name (Legal Business Name): CHANDA BROCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 N TARRYTOWN CROSSING DR
CONROE TX
77304-6821
US

IV. Provider business mailing address

8011 N TARRYTOWN CROSSING DR
CONROE TX
77304-6821
US

V. Phone/Fax

Practice location:
  • Phone: 832-896-8536
  • Fax:
Mailing address:
  • Phone: 832-896-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number980412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: