Provider Demographics
NPI:1487994869
Name:MOMIN, ANJU (FNP)
Entity type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:MOMIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 RAYFORD RD STE 644
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1519
Mailing Address - Country:US
Mailing Address - Phone:281-742-0624
Mailing Address - Fax:281-362-5977
Practice Address - Street 1:610 RAYFORD RD STE 644
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1519
Practice Address - Country:US
Practice Address - Phone:281-742-0624
Practice Address - Fax:281-362-5977
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX771653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily