Provider Demographics
NPI:1255182507
Name:RAJU, PRISCILLA O (LICENSE NURSE)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:O
Last Name:RAJU
Suffix:
Gender:F
Credentials:LICENSE NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 2741
Mailing Address - Street 2:
Mailing Address - City:SUGARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487
Mailing Address - Country:US
Mailing Address - Phone:832-670-8332
Mailing Address - Fax:
Practice Address - Street 1:8824 RIVERWELL CIRCLE WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083
Practice Address - Country:US
Practice Address - Phone:832-670-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341796385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care