Healthcare Provider Details

I. General information

NPI: 1538421334
Provider Name (Legal Business Name): NANCY JANE CLEGG RN, CNS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WELBORN ST DEPARTMENT OF NEUROLOGY
DALLAS TX
75219-3924
US

IV. Provider business mailing address

2222 WELBORN ST DEPARTMENT OF NEUROLOGY
DALLAS TX
75219-3924
US

V. Phone/Fax

Practice location:
  • Phone: 214-559-8411
  • Fax: 214-559-8383
Mailing address:
  • Phone: 214-559-8411
  • Fax: 214-559-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberAP107794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: