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NPI Code Detail

MEDICARE: PHYLLIS NJUE RN

MEDICARE:   PHYLLIS  NJUE  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse9481429TX

General Provider Information

NPI Number : 1093211831
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS NJUE RN
Provider Business Mailing Address
First Line : 5445 PRESTON OAKS RD APT 511
Second Line :
City : DALLAS
State : TX
Zip : 75254-2421
Country : US
Telephone Number : 682-558-9232
Fax Number :
Provider Business Practice Location Address
First Line : 5445 PRESTON OAKS RD APT 511
Second Line :
City : DALLAS
State : TX
Zip : 75254-2421
Country : US
Telephone Number : 682-558-9232
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2018
Last Update Date : 04/02/2018

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