MEDICARE: TINTU MARIAM RN CASE MANAGER

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	171M00000X	Case Manager/Care Coordinator	981224	TX
2	163W00000X	Registered Nurse	651119-1	NY

General Provider Information

NPI Number	:	1568992774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINTU MARIAM RN CASE MANAGER

Provider Business Mailing Address
First Line	:	5722 SLATE VALLEY CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5105
Country	:	US
Telephone Number	:	718-207-1108
Fax Number	:

Provider Business Practice Location Address
First Line	:	5722 SLATE VALLEY CT
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5105
Country	:	US
Telephone Number	:	718-207-1108
Fax Number	:

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	01/09/2026

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