MEDICARE: NISSY RAJAN

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	363LA2100X	Acute Care Nurse Practitioner	638342	TX

General Provider Information

NPI Number	:	1477805968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISSY RAJAN

Provider Business Mailing Address
First Line	:	2506 W MOUNT HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77038-3518
Country	:	US
Telephone Number	:	281-847-1133
Fax Number	:	281-847-1167

Provider Business Practice Location Address
First Line	:	2506 W MOUNT HOUSTON RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77038-3518
Country	:	US
Telephone Number	:	281-847-1133
Fax Number	:	281-847-1167

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

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	10/08/2012

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Directions to “ NISSY RAJAN ” Practice Location

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