MEDICARE: HELEN VARA PEACE

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1679039077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN VARA PEACE

Provider Business Mailing Address
First Line	:	2101 SYCAMORE AVE APT 728
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-6250
Country	:	US
Telephone Number	:	214-766-1690
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 GLEN AMERICA DR APT 131
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-1845
Country	:	US
Telephone Number	:	214-766-1690
Fax Number	:

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

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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