Healthcare Provider Details

I. General information

NPI: 1306669460
Provider Name (Legal Business Name): PRAJUNA GIRI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11353 SUGAR PARK LN
SUGAR LAND TX
77478-1407
US

IV. Provider business mailing address

6903 BRISBANE CT STE 100
SUGAR LAND TX
77479-6845
US

V. Phone/Fax

Practice location:
  • Phone: 281-276-2050
  • Fax:
Mailing address:
  • Phone: 832-886-4774
  • Fax: 832-786-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1179201
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: