Healthcare Provider Details

I. General information

NPI: 1366116360
Provider Name (Legal Business Name): 3D NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9013 OLD CLYDESDALE DR
FORT WORTH TX
76123-3547
US

IV. Provider business mailing address

9013 OLD CLYDESDALE DR
FORT WORTH TX
76123-3547
US

V. Phone/Fax

Practice location:
  • Phone: 682-560-5613
  • Fax: 817-453-4220
Mailing address:
  • Phone: 682-560-5613
  • Fax: 817-453-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER LAJUAN DANIELS I
Title or Position: CEO
Credential: RN
Phone: 682-560-5613