Healthcare Provider Details

I. General information

NPI: 1053704692
Provider Name (Legal Business Name): APPLIED NEUROPHYSIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 STANFORD AVE
DALLAS TX
75225-7006
US

IV. Provider business mailing address

6127 LUTHER LN # 492
DALLAS TX
75225-6202
US

V. Phone/Fax

Practice location:
  • Phone: 214-536-1647
  • Fax: 214-580-7600
Mailing address:
  • Phone: 214-536-1647
  • Fax: 214-580-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberH2492
License Number StateTX

VIII. Authorized Official

Name: DR. NOLAN BRUCE JENEVEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 214-738-4961