Healthcare Provider Details

I. General information

NPI: 1851901250
Provider Name (Legal Business Name): MS. MICHELE WEBSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 MEADOW ISLE LN
DALLAS TX
75237-3215
US

IV. Provider business mailing address

6414 ST LEONARD DR
ARLINGTON TX
76001-7847
US

V. Phone/Fax

Practice location:
  • Phone: 214-298-3887
  • Fax: 817-977-0201
Mailing address:
  • Phone: 702-885-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: