Provider Demographics
NPI:1679718233
Name:MICHAEL, MABEL (APRN)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 TIBURON TRL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6155
Mailing Address - Country:US
Mailing Address - Phone:832-244-0501
Mailing Address - Fax:
Practice Address - Street 1:7622 TIBURON TRL
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6155
Practice Address - Country:US
Practice Address - Phone:832-244-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1093979363LG0600X
TX008702251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169083601OtherTMHP
TX008702OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES
TX169083601OtherTMHP