MEDICARE: MARY RICH RN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	245251	TX

General Provider Information

NPI Number	:	1275958985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RICH RN FNP

Provider Business Mailing Address
First Line	:	14060 DUBLIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77085-1222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7319 OAK HILL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-5335
Country	:	US
Telephone Number	:	832-577-7872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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