Healthcare Provider Details

I. General information

NPI: 1023647914
Provider Name (Legal Business Name): PASAKA RAMOGI GWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S FRY RD
KATY TX
77450-2255
US

IV. Provider business mailing address

8107 LONGVALE DR
ROSENBERG TX
77469-5074
US

V. Phone/Fax

Practice location:
  • Phone: 281-599-5700
  • Fax:
Mailing address:
  • Phone: 281-704-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP144680
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: