Provider Demographics
NPI:1679671523
Name:STATEN, ROCHELLE LAVERNE (NP)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LAVERNE
Last Name:STATEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:LAVERNE
Other - Last Name:CALVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4150 WESTHEIMER
Mailing Address - Street 2:STE. 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027
Mailing Address - Country:US
Mailing Address - Phone:713-850-0049
Mailing Address - Fax:713-850-0036
Practice Address - Street 1:4150 WESTHEIMER
Practice Address - Street 2:STE. 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-850-0049
Practice Address - Fax:713-850-0036
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX458635363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157869202Medicaid
TX8Y0598OtherBCBS
TX8G9555Medicare PIN