Provider Demographics
NPI:1942846837
Name:USUDAN, MANSOUR ACMAD (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MANSOUR
Middle Name:ACMAD
Last Name:USUDAN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:MR
Other - First Name:MANSOUR
Other - Middle Name:
Other - Last Name:USUDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4825 S HUMMER LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3128
Mailing Address - Country:US
Mailing Address - Phone:956-424-5451
Mailing Address - Fax:
Practice Address - Street 1:208 STARR ST STE 1
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2736
Practice Address - Country:US
Practice Address - Phone:956-968-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily