Provider Demographics
NPI:1992346951
Name:PRIVITERA, LAHOMA (MSN, AGNP)
Entity type:Individual
Prefix:
First Name:LAHOMA
Middle Name:
Last Name:PRIVITERA
Suffix:
Gender:F
Credentials:MSN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 OLD SHEPARD PL STE 101
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5251
Mailing Address - Country:US
Mailing Address - Phone:214-919-2360
Mailing Address - Fax:
Practice Address - Street 1:4601 OLD SHEPARD PL., BUILDING ONE, SUITE 101
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7509
Practice Address - Country:US
Practice Address - Phone:214-919-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143228363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care