Athena Medical Clinic LLC
Nurse Practitioner in Brookshire, TX. Organization (NPI-2).
NPI number1760102644
StatusActive
Last updated in NPPESJun 23, 2023
Details
- NPI
- 1760102644
- Entity type
- Organization (NPI-2)
- Legal business name
- Athena Medical Clinic LLC
- Organization subpart
- No
- Enumeration date
- Aug 31, 2022
- Certification date
- Jun 23, 2023
- Last updated
- Jun 23, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | – | – | Yes |
Other names
- Athena Medical Clinic LLC (Former Legal Business Name)
Practice location
30575 Kingsland Blvd # 150Brookshire, TX 77423-2844
Phone 281-717-4674
Mailing address
30575 Kingsland Blvd # 150Brookshire, TX 77423-2844
Phone 281-717-4674 · Fax 833-318-0533
Authorized official
Iolani Mae Sy Aves
Managing Member
7135849013
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