MEDICARE: LACHERIA VANBUREN 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	363L00000X	Nurse Practitioner	AP131791	TX
2	363LF0000X	Family Nurse Practitioner	AP131791	TX

General Provider Information

NPI Number	:	1790221919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACHERIA VANBUREN FNP

Provider Business Mailing Address
First Line	:	3129 KINGSLEY DR STE 1010
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-8509
Country	:	US
Telephone Number	:	832-304-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	3129 KINGSLEY DR STE 1010
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-8509
Country	:	US
Telephone Number	:	832-304-4665
Fax Number	:

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

Provider Enumeration Date	:	01/11/2017
Last Update Date	:	01/07/2025

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Directions to “ LACHERIA VANBUREN FNP” Practice Location

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