MEDICARE: AMY G BOX RNFA

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
1	163WR0006X	Registered Nurse First Assistant	606033	TX

General Provider Information

NPI Number	:	1245878669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY G BOX RNFA

Provider Business Mailing Address
First Line	:	8915 SAN FERNANDO WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8915 SAN FERNANDO WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4036
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	01/25/2024

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