=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871189712
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVANA PRISCILLA BUAMAH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2020
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 429 E INTERSTATE 30 STE 114
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-4097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-795-3292
-----------------------------------------------------
Fax | 972-767-0334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3304 CREEKSIDE DR
-----------------------------------------------------
City | SACHSE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75048-2366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-821-2501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1015129
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------