Healthcare Provider Details

I. General information

NPI: 1720724099
Provider Name (Legal Business Name): NUVI DOH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 JOSHUA RD
FRISCO TX
75033-3382
US

IV. Provider business mailing address

7560 JOSHUA RD
FRISCO TX
75033-3382
US

V. Phone/Fax

Practice location:
  • Phone: 747-777-0255
  • Fax:
Mailing address:
  • Phone: 747-777-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number15997
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: