MEDICARE: TOCURRA A' SHUNITA WONG APRN

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	363LF0000X	Family Nurse Practitioner	AP142259	TX
2	163W00000X	Registered Nurse	851895	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	851895	OTHER	TX	TEXAS BOARD OF NURSING REGISTERED NURSE
2	AP142259	OTHER	TX	ADVANCE PRACTICE REGISTERED NURSE

General Provider Information

NPI Number	:	1790338051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOCURRA A' SHUNITA WONG APRN

Provider Business Mailing Address
First Line	:	363 N SAM HOUSTON PKWY E STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-2413
Country	:	US
Telephone Number	:	832-356-9460
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 N SAM HOUSTON PKWY E STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-2413
Country	:	US
Telephone Number	:	832-356-9460
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	05/16/2024

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