Provider Demographics
NPI:1649745142
Name:THAMPI, MANJU (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MANJU
Middle Name:
Last Name:THAMPI
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13306 SUN CANYON CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7614
Mailing Address - Country:US
Mailing Address - Phone:832-512-1954
Mailing Address - Fax:
Practice Address - Street 1:13306 SUN CANYON CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7614
Practice Address - Country:US
Practice Address - Phone:832-512-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138790363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care