Provider Demographics
NPI:1699104661
Name:IRABOR, STELLAMARIS (FNP-C)
Entity type:Individual
Prefix:
First Name:STELLAMARIS
Middle Name:
Last Name:IRABOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OAK DR S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5676
Mailing Address - Country:US
Mailing Address - Phone:979-266-9776
Mailing Address - Fax:979-529-2952
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-266-9776
Practice Address - Fax:979-529-2952
Is Sole Proprietor?:No
Enumeration Date:2013-11-10
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily