Healthcare Provider Details

I. General information

NPI: 1093194979
Provider Name (Legal Business Name): NODENS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 05/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 HEIRSHIP CT
FORT WORTH TX
76244-4966
US

IV. Provider business mailing address

4132 HEIRSHIP CT
FORT WORTH TX
76244-4966
US

V. Phone/Fax

Practice location:
  • Phone: 806-535-9197
  • Fax: 817-337-3032
Mailing address:
  • Phone: 806-535-9197
  • Fax: 817-337-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCO PENA
Title or Position: CERTIFIED SURGICAL FIRST ASSISTANT
Credential: CSFA/CST
Phone: 806-535-9197