Healthcare Provider Details

I. General information

NPI: 1457835530
Provider Name (Legal Business Name): MVP HEALTH & WELLNESS SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 BEAVERWOOD LN
CROWLEY TX
76036-4323
US

IV. Provider business mailing address

5601 BRIDGE ST STE 300
FORT WORTH TX
76112-2355
US

V. Phone/Fax

Practice location:
  • Phone: 210-817-8254
  • Fax: 210-981-1326
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CONSTANCE LAWRIW
Title or Position: OWNER/PROVIDER
Credential: ARNP-C
Phone: 210-817-8254