Individual
MARY E CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
P O BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
710251
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331918801
—
TX
01
—
885N23
BCBS
TX
Enumeration date
09/28/2012
Last updated
06/25/2014
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