MEDICARE: JEANAN ALAMEDDINE CPNP-AC

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	363LP0200X	Pediatric Nurse Practitioner	1011810	TX

General Provider Information

NPI Number	:	1457965436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANAN ALAMEDDINE CPNP-AC

Provider Business Mailing Address
First Line	:	6410 FANNIN ST STE 370
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 CATALPA PL
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5709
Country	:	US
Telephone Number	:	281-948-3916
Fax Number	:

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

Provider Enumeration Date	:	09/07/2020
Last Update Date	:	10/27/2021

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