=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023563616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSANGELA RAMIREZ AGNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2016
-----------------------------------------------------
Last Update Date | 11/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 N 23RD ST
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77707-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-839-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 N 23RD ST STE 201
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77707-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-839-4600
-----------------------------------------------------
Fax | 409-839-8110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | AP130881
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------