Healthcare Provider Details

I. General information

NPI: 1851808513
Provider Name (Legal Business Name): NICHELLE BANAG PACIA ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26440 FM 1093 RD STE 350
RICHMOND TX
77406-7200
US

IV. Provider business mailing address

12911 BONNIE LN
STAFFORD TX
77477-4563
US

V. Phone/Fax

Practice location:
  • Phone: 832-987-4831
  • Fax:
Mailing address:
  • Phone: 832-293-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0002
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: