1740671783 NPI number — MISS HEATHER ANN PLESSALA RN, FNP-C

Table of content: DR. NAN YOUNG KWON M.D (NPI 1962435727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740671783 NPI number — MISS HEATHER ANN PLESSALA RN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLESSALA
Provider First Name:
HEATHER
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740671783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3027 MARINA BAY DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
LEAGUE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77573-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-727-8187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5430 KNAUTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-727-8187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP126075 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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