Provider Demographics
NPI:1770580433
Name:PARANGIMALIL, ROSAMMA G (NP)
Entity type:Individual
Prefix:MRS
First Name:ROSAMMA
Middle Name:G
Last Name:PARANGIMALIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1002 TEXAS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5107
Mailing Address - Country:US
Mailing Address - Phone:903-792-4808
Mailing Address - Fax:903-792-2681
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5107
Practice Address - Country:US
Practice Address - Phone:903-792-4808
Practice Address - Fax:903-792-2681
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665338363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C8533Medicare ID - Type Unspecified
TXP18776Medicare UPIN