MEDICARE: JOANNA M. UTOH 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	AP4649	AZ
2	363LF0000X	Family Nurse Practitioner	AP125686	TX

General Provider Information

NPI Number	:	1407108772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA M. UTOH FNP

Provider Business Mailing Address
First Line	:	909 FROSTWOOD DR
Second Line	:	STE 1.100
City	:	HOUSTON
State	:	TX
Zip	:	77024-2301
Country	:	US
Telephone Number	:	713-338-4523
Fax Number	:

Provider Business Practice Location Address
First Line	:	5885 SAN FELIPE ST
Second Line	:	#325
City	:	HOUSTON
State	:	TX
Zip	:	77057
Country	:	US
Telephone Number	:	713-338-5517
Fax Number	:	713-338-4553

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

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	06/11/2018

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