Healthcare Provider Details

I. General information

NPI: 1780404657
Provider Name (Legal Business Name): MACMILLEN THOKOZANI REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23900 KATY FWY
KATY TX
77494-1323
US

IV. Provider business mailing address

29015 KNOLLWOOD TRAIL LN
KATY TX
77494-3877
US

V. Phone/Fax

Practice location:
  • Phone: 281-644-7000
  • Fax:
Mailing address:
  • Phone: 540-569-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number921722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: