Healthcare Provider Details

I. General information

NPI: 1063107852
Provider Name (Legal Business Name): HAILIE NICOLE CIOMPERLIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BAYLOR PLAZA
HOUSTON TX
77030
US

IV. Provider business mailing address

811 BUFFALO PARK DR APT 1512
HOUSTON TX
77019-2215
US

V. Phone/Fax

Practice location:
  • Phone: 832-826-7354
  • Fax:
Mailing address:
  • Phone: 956-874-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: