Basic Information
| Provider Information | |||||||||
| NPI: | 1851982664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DJAM | ||||||||
| FirstName: | PATIENCE | ||||||||
| MiddleName: | FULAI | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3202 RUBY STAR DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770821272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403608025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2424 WILCREST DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770422772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136668287 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2021 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SH0200X | 9553827 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Home Health |
No ID Information.