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General NPI Number Information
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NPI Number | 1487842324
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Entity Type | Organization
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Legal Business Name | ASSISTANT AT SURGERY PRN
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 18306 BLANCHMONT LN
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City | HOUSTON
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State | TX
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Zip | 77058-3427
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Country | US
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Telephone | 281-335-0411
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Fax | 281-333-1075
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Provider Business Mailing Address
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Address Line | PO BOX 58265
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City | HOUSTON
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State | TX
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Zip | 77258-8265
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Country | US
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Telephone | 281-335-0411
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Fax | 281-333-1075
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Authorized Official
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Title or Position | ASSISTANT
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Name | OPAL HERRSCHER
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Credential | RNFA CNOR
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Telephone | 281-335-0411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 550275
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License Number State | TX
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