Most Relevant Information
Provider Data
| NPI Number: | 1003455387 |
| Provider Name: | POONAM GUPTA |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | AP143718 |
Most Important Dates
| Enumeration Date: | 01/03/2020 |
| Last Updated: | 01/03/2020 |
Provider Practice Location
4714 FM 1488 RD STE 132
CONROE
TX
773844930
Practice Location Phone/Fax
| Phone: | 8778682528 |
| Fax: |
Provider Mailing Location
4714 FM 1488 RD STE 132
CONROE
TX
773844930
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |