Provider Demographics
NPI:1154993996
Name:PORAMAPORNPILAS, NONGLAK (NP)
Entity type:Individual
Prefix:MISS
First Name:NONGLAK
Middle Name:
Last Name:PORAMAPORNPILAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 HORSETAIL CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-1102
Mailing Address - Country:US
Mailing Address - Phone:935-223-5351
Mailing Address - Fax:
Practice Address - Street 1:8218 HORSETAIL CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-1102
Practice Address - Country:US
Practice Address - Phone:935-223-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046715363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22423616OtherDRIVER LICENSE