Healthcare Provider Details

I. General information

NPI: 1649830878
Provider Name (Legal Business Name): MACI HEURING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 US HIGHWAY 287 ACCESS RD N APT 217
HENRIETTA TX
76365-1505
US

IV. Provider business mailing address

1600 US HIGHWAY 287 ACCESS RD N APT 217
HENRIETTA TX
76365-1505
US

V. Phone/Fax

Practice location:
  • Phone: 940-632-8252
  • Fax:
Mailing address:
  • Phone: 940-632-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number970255
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: