MEDICARE: VIVIAN IRABOR

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	363LP2300X	Primary Care Nurse Practitioner	AP127851	TX

General Provider Information

NPI Number	:	1902284508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN IRABOR

Provider Business Mailing Address
First Line	:	9215 CLEARWATER RANCH LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9215 CLEARWATER RANCH LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1701
Country	:	US
Telephone Number	:	281-265-0409
Fax Number	:

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

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	10/17/2016

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Directions to “ VIVIAN IRABOR ” Practice Location

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