Provider Demographics
NPI:1730632282
Name:ABEGUNDE, MIHOKO WATANABE (NP)
Entity type:Individual
Prefix:
First Name:MIHOKO
Middle Name:WATANABE
Last Name:ABEGUNDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIHOKO
Other - Middle Name:
Other - Last Name:WATANABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-8650
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-8650
Practice Address - Fax:214-645-0078
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130658363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology