=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104324128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RECHEL G. DELANTAR FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2018
-----------------------------------------------------
Last Update Date | 01/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16523 BERKSHIRE FOREST DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-986-2677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16523 BERKSHIRE FOREST DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-986-2677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP136243
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------