Healthcare Provider Details

I. General information

NPI: 1558978569
Provider Name (Legal Business Name): LAURA NASRALLAH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 HOSPITAL PKWY
BEDFORD TX
76022-6920
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 817-359-9096
  • Fax: 817-354-8969
Mailing address:
  • Phone: 817-359-9096
  • Fax: 817-354-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1011411
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: