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General NPI Number Information
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NPI Number | 1821600487
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Entity Type | Individual
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Provider Name | FRISTANTO KURNIAWAN MSN, RN, AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 9250 PINECROFT DR
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City | SHENANDOAH
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State | TX
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Zip | 77380-3218
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Country | US
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Telephone | 713-897-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 MEDICAL PLAZA DR STE 250
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3477
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Country | US
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Telephone | 281-296-8788
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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 | 1006744
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License Number State | TX
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