Healthcare Provider Details

I. General information

NPI: 1730478884
Provider Name (Legal Business Name): HEATHER NICOLLE HUMMEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR GRADUATE MEDICAL EDUCATION
DALLAS TX
75235-7701
US

IV. Provider business mailing address

2017 EAST BROADWAY
PEARLAND TX
77581
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-2735
  • Fax:
Mailing address:
  • Phone: 281-485-9990
  • Fax: 281-485-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP9593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: