Provider Demographics
NPI:1366037905
Name:EMMETT, DEMETREAL
Entity Type:Individual
Prefix:
First Name:DEMETREAL
Middle Name:
Last Name:EMMETT
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 1:54 SUGAR CREEK CENTER BLVD STE 221
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4064
Mailing Address - Country:US
Mailing Address - Phone:832-886-2807
Mailing Address - Fax:
Practice Address - Street 1:54 SUGAR CREEK CENTER BLVD STE 221
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4064
Practice Address - Country:US
Practice Address - Phone:832-886-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide