Provider Demographics
NPI:1487830469
Name:NORTHWEST NURSE PRACTITIONERS CLINIC, LLC
Entity Type:Organization
Organization Name:NORTHWEST NURSE PRACTITIONERS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:281-858-6611
Mailing Address - Street 1:16125 CAIRNWAY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3556
Mailing Address - Country:US
Mailing Address - Phone:281-858-6611
Mailing Address - Fax:281-858-6605
Practice Address - Street 1:16125 CAIRNWAY DR STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3556
Practice Address - Country:US
Practice Address - Phone:281-858-6611
Practice Address - Fax:281-858-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552857363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176440901Medicaid
TX176440902Medicaid
TX00572ZMedicare PIN
TXQ17733Medicare UPIN