Provider Demographics
NPI:1851048151
Name:KAWSZAN, THEODORA ALICE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:ALICE
Last Name:KAWSZAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20547
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225
Mailing Address - Country:US
Mailing Address - Phone:832-544-1056
Mailing Address - Fax:
Practice Address - Street 1:16605 SOUTHWEST FREEWAY, SUITE 175
Practice Address - Street 2:
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-302-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner