=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255182507
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRISCILLA O RAJU LICENSE NURSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2024
-----------------------------------------------------
Last Update Date | 03/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8824 RIVERWELL CIRCLE WEST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-670-8332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 2741
-----------------------------------------------------
City | SUGARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-670-8332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | 341796
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------