Healthcare Provider Details

I. General information

NPI: 1922413095
Provider Name (Legal Business Name): RENE HABINUCHI AMADI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 N HIGHWAY 377 STE 110
PILOT POINT TX
76258-3764
US

IV. Provider business mailing address

1340 N HIGHWAY 377 STE 110
PILOT POINT TX
76258-3764
US

V. Phone/Fax

Practice location:
  • Phone: 940-686-0860
  • Fax:
Mailing address:
  • Phone: 940-686-0860
  • Fax: 940-686-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: