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General NPI Number Information
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NPI Number | 1740924265
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Entity Type | Organization
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Legal Business Name | PHOENIX MEDICAL & WELLNESS CLINIC, PLLC
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 12240 MURPHY RD STE A
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City | STAFFORD
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State | TX
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Zip | 77477-2411
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Country | US
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Telephone | 281-721-2918
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Fax | 346-342-1941
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Provider Business Mailing Address
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Address Line | 18 LA SERRA PATH
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City | MISSOURI CITY
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State | TX
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Zip | 77459-1779
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Country | US
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Telephone | 469-579-7020
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | ANASTANSIA MONAYP RATEMO
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Credential | FNP
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Telephone | 469-579-7020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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