Individual
MIRA MAYA TAMANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
NP
Contact information
Practice address
3604 LIVE OAK ST STE 100, DALLAS, TX 75204-6169
(214) 358-2300
(214) 579-6985
Mailing address
1505 LBJ FWY STE 700, DALLAS, TX 75234-6065
(214) 358-2300
(214) 579-6985
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1182426
TX
363LG0600X
Gerontology Nurse Practitioner
1182426
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1182426
NURSES LICENSE
TX
01
—
928784
RN LICENSE
TX
Enumeration date
03/11/2025
Last updated
03/14/2025
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