Provider Demographics
NPI:1023648680
Name:AMATAJ, ARJANA
Entity type:Individual
Prefix:
First Name:ARJANA
Middle Name:
Last Name:AMATAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 MEMORIAL DR UNIT 541
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8405
Mailing Address - Country:US
Mailing Address - Phone:832-477-7242
Mailing Address - Fax:
Practice Address - Street 1:1206 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3820
Practice Address - Country:US
Practice Address - Phone:346-319-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX958747163W00000X
TX1075583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse