Provider Demographics
NPI:1275112567
Name:MOMIN, SHERMIN S
Entity Type:Individual
Prefix:MRS
First Name:SHERMIN
Middle Name:S
Last Name:MOMIN
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 1:20114 REDWICK CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5569
Mailing Address - Country:US
Mailing Address - Phone:832-798-0584
Mailing Address - Fax:
Practice Address - Street 1:17350 ST LUKES WAY STE 350
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4103
Practice Address - Country:US
Practice Address - Phone:281-203-5115
Practice Address - Fax:281-203-5119
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907623163W00000X
TX1048220363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
12345OtherNONE