Provider Demographics
NPI:1316327026
Name:KABURU, MARY W
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:W
Last Name:KABURU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:W
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2323 POLK ST APT 307
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-4407
Mailing Address - Country:US
Mailing Address - Phone:832-855-2696
Mailing Address - Fax:713-583-8095
Practice Address - Street 1:2323 POLK ST APT 307
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-4407
Practice Address - Country:US
Practice Address - Phone:832-443-7601
Practice Address - Fax:713-583-8095
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX788781363LF0000X
TXAP12747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily