Provider Demographics
NPI:1215193552
Name:MAHMUD, NATHALIE GIGWISHIA (NP STUDENT)
Entity type:Individual
Prefix:MISS
First Name:NATHALIE
Middle Name:GIGWISHIA
Last Name:MAHMUD
Suffix:
Gender:F
Credentials:NP STUDENT
Other - Prefix:
Other - First Name:NATHALIE
Other - Middle Name:GIGWISHIA
Other - Last Name:KOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13303 REDWOOD TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-0436
Mailing Address - Country:US
Mailing Address - Phone:832-947-8450
Mailing Address - Fax:
Practice Address - Street 1:6500 HORNWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5095
Practice Address - Country:US
Practice Address - Phone:832-947-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY582412-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program