Provider Demographics
NPI:1104673680
Name:FIELDS, MIGNON (CD)
Entity type:Individual
Prefix:
First Name:MIGNON
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 PURPLE SAGE RD APT 211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4344
Mailing Address - Country:US
Mailing Address - Phone:832-350-8516
Mailing Address - Fax:
Practice Address - Street 1:5675 PURPLE SAGE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4306
Practice Address - Country:US
Practice Address - Phone:832-350-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT141184225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist