=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114562659
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHSHID SARRAMI NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2019
-----------------------------------------------------
Last Update Date | 11/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2477 MORNING DEW DR
-----------------------------------------------------
City | LITTLE ELM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75068-7630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-232-8558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2477 MORNING DEW DR
-----------------------------------------------------
City | LITTLE ELM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75068-7630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-232-8558
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 2019072470
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------