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General NPI Number Information
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NPI Number | 1154186765
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Entity Type | Individual
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Provider Name | BERSABEH MULUGETA SAMUEL ACNP
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Gender | Female
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 3001 E PRESIDENT GEORGE BUSH HWY STE 210
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City | RICHARDSON
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State | TX
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Zip | 75082-3552
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Country | US
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Telephone | 469-204-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 3449 FOXBORO DR
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City | RICHARDSON
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State | TX
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Zip | 75082-4124
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Country | US
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Telephone | 832-798-2506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1146085
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License Number State | TX
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