Provider Demographics
NPI:1174969893
Name:AMEH, RAISSA (WHNP, MSN)
Entity type:Individual
Prefix:
First Name:RAISSA
Middle Name:
Last Name:AMEH
Suffix:
Gender:F
Credentials:WHNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 HOGAN DR
Mailing Address - Street 2:#1409
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75709-6930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:649 S BROADWAY AVE
Practice Address - Street 2:STE. 2
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1677
Practice Address - Country:US
Practice Address - Phone:903-939-2273
Practice Address - Fax:903-581-2137
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2371363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health