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Organization
BAYLOR COLLEGE OF MEDICINE
Active
Organization
BAYLOR COLLEGE OF MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. COREEN VON FAZAKERLY MSN, ANP-C (NURSE PRACTITIONER)
(713) 798-4696
Entity
Organization
Contact information
Practice address
1709 DRYDEN RD, 750, HOUSTON, TX 77030-2400
(713) 798-4696
(713) 798-3739
Mailing address
5012 JACKWOOD ST, HOUSTON, TX 77096-1507
(713) 664-8862
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
511846
TX
Other
Enumeration date
05/27/2008
Last updated
05/27/2008
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