Healthcare Provider Details

I. General information

NPI: 1144648239
Provider Name (Legal Business Name): NICOLE SWEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E LAMAR BLVD STE 400
ARLINGTON TX
76006-7353
US

IV. Provider business mailing address

2000 E LAMAR BLVD STE 400
ARLINGTON TX
76006-7353
US

V. Phone/Fax

Practice location:
  • Phone: 817-583-7432
  • Fax: 682-227-6609
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105244
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: