Healthcare Provider Details

I. General information

NPI: 1679743264
Provider Name (Legal Business Name): JUDITH LYNN GELWIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 LA VISTA DR
DALLAS TX
75214-4032
US

IV. Provider business mailing address

6840 LA VISTA DR
DALLAS TX
75214-4032
US

V. Phone/Fax

Practice location:
  • Phone: 972-953-6737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number600966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: