Provider Demographics
NPI:1932689270
Name:MIRABEAU, BAPI (RNBSN)
Entity Type:Individual
Prefix:
First Name:BAPI
Middle Name:
Last Name:MIRABEAU
Suffix:
Gender:M
Credentials:RNBSN
Other - Prefix:DR
Other - First Name:MIRABEAU
Other - Middle Name:K
Other - Last Name:BAPI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD ,RNBSN
Mailing Address - Street 1:171 CORLEY CIR
Mailing Address - Street 2:
Mailing Address - City:WAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5862
Mailing Address - Country:US
Mailing Address - Phone:240-618-7785
Mailing Address - Fax:
Practice Address - Street 1:171 CORLEY CIR
Practice Address - Street 2:
Practice Address - City:WAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75501-5862
Practice Address - Country:US
Practice Address - Phone:240-618-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX831572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse