Provider Demographics
NPI:1336788066
Name:NOUSSI, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:NOUSSI
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 1:9901 RICHMOND AVE APT 527
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4597
Mailing Address - Country:US
Mailing Address - Phone:760-577-1008
Mailing Address - Fax:
Practice Address - Street 1:5627 LAUREL CREEK WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-6838
Practice Address - Country:US
Practice Address - Phone:832-374-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty