Basic Information
Provider Information
NPI: 1295259547
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEBASTIAN
FirstName: REENA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 COMMERCE ST STE 700
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372011835
CountryCode: US
TelephoneNumber: 6156272293
FaxNumber: 8884942588
Practice Location
Address1: 2425 WEST LOOP S STE 200
Address2:  
City: HOUSTON
State: TX
PostalCode: 770274208
CountryCode: US
TelephoneNumber: 8327864970
FaxNumber: 8557375542
Other Information
ProviderEnumerationDate: 07/28/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP2300XAP134538TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care

No ID Information.


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