Healthcare Provider Details

I. General information

NPI: 1205477908
Provider Name (Legal Business Name): EVELYN HERNANDEZ CATUNGAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N TOM GREEN AVE
ODESSA TX
79761-5145
US

IV. Provider business mailing address

405 N TOM GREEN AVE
ODESSA TX
79761-5145
US

V. Phone/Fax

Practice location:
  • Phone: 432-580-9876
  • Fax: 432-580-9877
Mailing address:
  • Phone: 432-580-9876
  • Fax: 432-580-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number723853
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: