Provider Demographics
NPI:1154186765
Name:SAMUEL, BERSABEH MULUGETA (ACNP)
Entity type:Individual
Prefix:
First Name:BERSABEH
Middle Name:MULUGETA
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 FOXBORO DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4124
Mailing Address - Country:US
Mailing Address - Phone:832-798-2506
Mailing Address - Fax:
Practice Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY STE 210
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3552
Practice Address - Country:US
Practice Address - Phone:469-204-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146085363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty