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General NPI Number Information
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NPI Number | 1053624015
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Entity Type | Organization
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Legal Business Name | NURSE PRACTITIONER PROVIDER
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 2626 S LOOP W 350
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City | HOUSTON
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State | TX
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Zip | 77054-2654
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Country | US
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Telephone | 713-334-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 16731 BETHAN GLEN LN
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City | HOUSTON
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State | TX
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Zip | 77084-2651
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Country | US
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Telephone | 281-686-4469
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Fax | 281-858-7618
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | RHONJEAN GORDON
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Credential | RN-FNP-BC
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Telephone | 281-686-4469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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