Healthcare Provider Details

I. General information

NPI: 1528658788
Provider Name (Legal Business Name): NORTHSTAR HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 FM 2920 RD
SPRING TX
77388-3676
US

IV. Provider business mailing address

5340 WESLAYAN ST # 273407
HOUSTON TX
77005-1048
US

V. Phone/Fax

Practice location:
  • Phone: 713-352-9439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KEILAN PETERSON
Title or Position: CEO
Credential:
Phone: 713-352-9439