Healthcare Provider Details

I. General information

NPI: 1487159174
Provider Name (Legal Business Name): NICOLE LAW CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W ARBROOK BLVD STE 250
ARLINGTON TX
76015-4393
US

IV. Provider business mailing address

1401 HIGHWAY 360 APT 1226
EULESS TX
76039-5241
US

V. Phone/Fax

Practice location:
  • Phone: 817-375-5755
  • Fax:
Mailing address:
  • Phone: 214-952-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP137117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: