Basic Information
| Provider Information | |||||||||
| NPI: | 1972268399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAGHUNATH | ||||||||
| FirstName: | BRIANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1729 WESTON BRENT LN STE A | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799353013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152569751 | ||||||||
| FaxNumber: | 9159742344 | ||||||||
| Practice Location | |||||||||
| Address1: | 9999 KENWORTHY ST STE 1000 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799244412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152983434 | ||||||||
| FaxNumber: | 9152983434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2021 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 866130 | TX | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 1056906 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1056906 | 01 | TX | APRN-CNP | OTHER | 866130 | 01 | TX | RN | OTHER |