Provider Demographics
NPI:1295492650
Name:SAJAN, REENU
Entity type:Individual
Prefix:
First Name:REENU
Middle Name:
Last Name:SAJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAKEWAY CENTRE CT STE A
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2757
Mailing Address - Country:US
Mailing Address - Phone:512-610-3110
Mailing Address - Fax:
Practice Address - Street 1:4 LAKEWAY CENTRE CT STE A
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-2757
Practice Address - Country:US
Practice Address - Phone:512-610-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily