1891265930 NPI number — BRINDA MATAMANA MSN, FNP-C, APRN

Table of content: BRINDA MATAMANA MSN, FNP-C, APRN (NPI 1891265930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891265930 NPI number — BRINDA MATAMANA MSN, FNP-C, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATAMANA
Provider First Name:
BRINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-C, APRN
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:
1891265930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/20/2023
NPI Reactivation Date:
10/06/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1464 WILLIAM WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMERS BRANCH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-1332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-814-6488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12606 GREENVILLE AVE STE 185
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-547-6541
Provider Business Practice Location Address Fax Number:
469-547-6545
Provider Enumeration Date:
12/02/2018

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: 363L00000X , with the licence number:  AP139045 , 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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