Provider Demographics
NPI:1114650884
Name:POUDEL, ANIJA
Entity type:Individual
Prefix:
First Name:ANIJA
Middle Name:
Last Name:POUDEL
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 1:4305 W WHEATLAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3455
Mailing Address - Country:US
Mailing Address - Phone:972-708-9494
Mailing Address - Fax:972-708-9498
Practice Address - Street 1:4305 W WHEATLAND RD STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3455
Practice Address - Country:US
Practice Address - Phone:972-708-9494
Practice Address - Fax:972-708-9498
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1075599207QA0505X, 363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty