Healthcare Provider Details

I. General information

NPI: 1962981316
Provider Name (Legal Business Name): NE TEXAS NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 WALNUT HILL LN STE 220
DALLAS TX
75231-4425
US

IV. Provider business mailing address

8230 WALNUT HILL LN STE 220
DALLAS TX
75231-4425
US

V. Phone/Fax

Practice location:
  • Phone: 214-750-3646
  • Fax: 214-363-8299
Mailing address:
  • Phone: 214-750-3646
  • Fax: 214-363-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SARA BLAKELY
Title or Position: PRACTICE ADMINISTRATO
Credential:
Phone: 214-445-6959