Healthcare Provider Details

I. General information

NPI: 1376283192
Provider Name (Legal Business Name): NOVA BROOK HOULIHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NOVA BROOK MEBANE DO

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SCENIC DR
GEORGETOWN TX
78626-7726
US

IV. Provider business mailing address

2000 SCENIC DR
GEORGETOWN TX
78626-7726
US

V. Phone/Fax

Practice location:
  • Phone: 512-943-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV7579
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: