Provider Demographics
NPI:1417544313
Name:PROACTIVE PEDIATRIC NURSING SERVICES, PPLC
Entity Type:Organization
Organization Name:PROACTIVE PEDIATRIC NURSING SERVICES, PPLC
Other - Org Name:PROACTIVE NURSING SERVICE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:O
Authorized Official - Last Name:UGWU
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN
Authorized Official - Phone:832-213-9716
Mailing Address - Street 1:17711 SAUKI LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2847
Mailing Address - Country:US
Mailing Address - Phone:832-213-9716
Mailing Address - Fax:
Practice Address - Street 1:17711 SAUKI LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2847
Practice Address - Country:US
Practice Address - Phone:832-213-9716
Practice Address - Fax:979-773-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health