Provider Demographics
NPI:1922496157
Name:BEZWADA, MADHUMITHA P (CRNP)
Entity Type:Individual
Prefix:
First Name:MADHUMITHA
Middle Name:P
Last Name:BEZWADA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR STE 1.100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-6353
Mailing Address - Fax:
Practice Address - Street 1:19675 1-45 SOUTH
Practice Address - Street 2:STE 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-8761
Practice Address - Country:US
Practice Address - Phone:281-465-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR182801363LF0000X
TX921575363LF0000X
TXAP133626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR182801OtherSTATE LICENSE
MDF1114030OtherBOARD CERTIFICATION - AMERICAN ACADEMY OF NURSE PRACTITIONERS