Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP144680 | TX |
NPI | 1023647914 |
---|---|
Provider Name | Pasaka Ramogi Gwan |
First Address | Rosenberg, TX 77469-5074 |
Second Address | Katy, TX 77450-2255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2020 |
Last Update Date | 03/04/2020 |