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General NPI Number Information
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NPI Number | 1750197307
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Entity Type | Organization
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Legal Business Name | LIGHTHEARTED CARE AND WELLNESS LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 23 SAN SIMEON DR
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City | MANVEL
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State | TX
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Zip | 77578-3286
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Country | US
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Telephone | 337-532-1615
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Fax |
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Provider Business Mailing Address
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Address Line | 23 SAN SIMEON DR
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City | MANVEL
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State | TX
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Zip | 77578-3286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FNP- BC
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Name | OBIAGELI DUROUSSEAU
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Credential |
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Telephone | 337-532-1615
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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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