Healthcare Provider Details

I. General information

NPI: 1811303845
Provider Name (Legal Business Name): LKW RNFA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 N CENTRAL EXPY 120
DALLAS TX
75231-1050
US

IV. Provider business mailing address

10830 N CENTRAL EXPY 120
DALLAS TX
75231-1050
US

V. Phone/Fax

Practice location:
  • Phone: 214-378-9898
  • Fax: 214-378-9888
Mailing address:
  • Phone: 214-378-9898
  • Fax: 214-378-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number773834
License Number StateTX

VIII. Authorized Official

Name: LISA K WEAVER
Title or Position: PRESIDENT
Credential: RNFA
Phone: 214-378-9898