Healthcare Provider Details

I. General information

NPI: 1548967904
Provider Name (Legal Business Name): EDDINNA LAFAYE HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W MOCKINGBIRD LN UNIT 480
DALLAS TX
75247-5028
US

IV. Provider business mailing address

1111 W MOCKINGBIRD LN UNIT 480
DALLAS TX
75247-5028
US

V. Phone/Fax

Practice location:
  • Phone: 972-489-5552
  • Fax: 318-577-1559
Mailing address:
  • Phone: 972-489-5552
  • Fax: 318-577-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: