Healthcare Provider Details

I. General information

NPI: 1801331624
Provider Name (Legal Business Name): PAULINE MOPUR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CROWN COLONY DR
LUFKIN TX
75901-7715
US

IV. Provider business mailing address

501 CROWN COLONY DR
LUFKIN TX
75901-7715
US

V. Phone/Fax

Practice location:
  • Phone: 224-622-1673
  • Fax:
Mailing address:
  • Phone: 224-622-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number770059
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: