=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821895442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. SUPIN VARGHESE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2025
-----------------------------------------------------
Last Update Date | 03/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1504 TAUB LOOP
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-873-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2237 BAYLEAF MANOR DR
-----------------------------------------------------
City | MANVEL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77578-5368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-964-4791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 1190794
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------