MEDICARE: DEEBA KOROUS NP

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	363L00000X	Nurse Practitioner	1097435	TX

General Provider Information

NPI Number	:	1477270007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEBA KOROUS NP

Provider Business Mailing Address
First Line	:	2942 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-6907
Country	:	US
Telephone Number	:	214-381-1187
Fax Number	:	214-381-7213

Provider Business Practice Location Address
First Line	:	2942 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-6907
Country	:	US
Telephone Number	:	214-381-1187
Fax Number	:	214-381-7213

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

Provider Enumeration Date	:	10/25/2022
Last Update Date	:	10/25/2022

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