Provider Demographics
NPI:1003380437
Name:EGYAWAN, DORIS K (NP)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:K
Last Name:EGYAWAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 YOSEMITE TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2583
Mailing Address - Country:US
Mailing Address - Phone:240-422-6374
Mailing Address - Fax:
Practice Address - Street 1:624 YOSEMITE TRL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2583
Practice Address - Country:US
Practice Address - Phone:240-422-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty