Provider Demographics
NPI:1821466129
Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUSTON
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:KOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN, NNP-BC
Authorized Official - Phone:832-814-5411
Mailing Address - Street 1:2701 SHALLOW FALLS CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-6523
Mailing Address - Country:US
Mailing Address - Phone:832-814-5411
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125566282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren