Provider Demographics
NPI:1033779483
Name:KHANAM, TOHURA
Entity Type:Individual
Prefix:
First Name:TOHURA
Middle Name:
Last Name:KHANAM
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 1:12722 SCOTCH GROVE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1885
Mailing Address - Country:US
Mailing Address - Phone:954-842-0609
Mailing Address - Fax:
Practice Address - Street 1:12722 SCOTCH GROVE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1885
Practice Address - Country:US
Practice Address - Phone:954-842-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX968013163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse