MEDICARE: DR. DAISY GEORGE MULLASSERY DRNP

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	363L00000X	Nurse Practitioner	AP123473	TX
2	363LW0102X	Women's Health Nurse Practitioner	SP 011058	PA
3	363LW0102X	Women's Health Nurse Practitioner	AP123473	TX

General Provider Information

NPI Number	:	1770868663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAISY GEORGE MULLASSERY DRNP

Provider Business Mailing Address
First Line	:	26015 GALENA STONE LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-2608
Country	:	US
Telephone Number	:	267-342-1117
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3014
Country	:	US
Telephone Number	:	713-500-3267
Fax Number	:

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

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	01/16/2023

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