Provider Demographics
NPI:1740700301
Name:FADARE, TONIA (NP)
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:FADARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:
Other - Last Name:CARDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6414 FANNIN ST STE G125
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:713-500-5484
Practice Address - Street 1:23900 KATY FWY
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1323
Practice Address - Country:US
Practice Address - Phone:281-644-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704328162363L00000X
GARN296727363L00000X
TX1055661363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner