Healthcare Provider Details

I. General information

NPI: 1841795093
Provider Name (Legal Business Name): SHIRLEY GEORGINA RIORDAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 PRESTON RD STE 210W
DALLAS TX
75240-4986
US

IV. Provider business mailing address

3201 BRIGHTON CV
GRAPEVINE TX
76051-1101
US

V. Phone/Fax

Practice location:
  • Phone: 972-702-0300
  • Fax:
Mailing address:
  • Phone: 786-376-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number928769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: