Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 133176 | TX |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 133176 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | 133176 | TX |
NPI | 1013439934 |
---|---|
Provider Name | Shereen Raju Varughese |
First Address | Garland, TX 75043-0911 |
Second Address | Garland, TX 75043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 25/10/2018 |