MEDICARE: HONORINE NCHUO BETAH PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1049139	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61454755	WA

General Provider Information

NPI Number	:	1386310647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HONORINE NCHUO BETAH PMHNP-BC

Provider Business Mailing Address
First Line	:	18383 PRESTON RD STE 202
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5487
Country	:	US
Telephone Number	:	214-983-9811
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 FREMONT AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6527
Country	:	US
Telephone Number	:	855-444-7258
Fax Number	:

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

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	10/30/2023

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