Healthcare Provider Details

I. General information

NPI: 1962969303
Provider Name (Legal Business Name): HANNAH ROVILLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LINDENCREST CT
SUGAR LAND TX
77479-5201
US

IV. Provider business mailing address

103 LINDENCREST CT
SUGAR LAND TX
77479-5201
US

V. Phone/Fax

Practice location:
  • Phone: 281-980-4850
  • Fax:
Mailing address:
  • Phone: 281-980-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number942078
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: