Healthcare Provider Details

I. General information

NPI: 1225459522
Provider Name (Legal Business Name): MARCINE KOWPAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2014
Last Update Date: 01/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CYPRESS CREEK PKWY
HOUSTON TX
77090-3402
US

IV. Provider business mailing address

16002 LOCKDALE LN
CYPRESS TX
77429-8128
US

V. Phone/Fax

Practice location:
  • Phone: 281-440-2266
  • Fax:
Mailing address:
  • Phone: 281-225-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number447753
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: