Healthcare Provider Details

I. General information

NPI: 1790943843
Provider Name (Legal Business Name): ANGELA MCLEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 W NW HWY
DALLAS TX
75225-4202
US

IV. Provider business mailing address

400 S HENDERSON ST
FORT WORTH TX
76104-1017
US

V. Phone/Fax

Practice location:
  • Phone: 214-691-5466
  • Fax: 214-691-7250
Mailing address:
  • Phone: 817-335-2583
  • Fax: 817-335-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: