Individual
SALLY MICHELLE MUTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
6651 MAIN ST, HOUSTON, TX 77030-2351
(832) 826-1929
Mailing address
1218 BLUEBONNET DR, SEABROOK, TX 77586-4722
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
686744
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
N/A
—
Enumeration date
10/16/2018
Last updated
10/16/2018
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