Healthcare Provider Details

I. General information

NPI: 1952934317
Provider Name (Legal Business Name): KODZO DELALI TSOLENYANU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7019 PEPPER CREST LN
SPRING TX
77379-1435
US

IV. Provider business mailing address

7019 PEPPER CREST LN
SPRING TX
77379-1435
US

V. Phone/Fax

Practice location:
  • Phone: 832-766-2291
  • Fax:
Mailing address:
  • Phone: 832-766-2291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145091
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: