Healthcare Provider Details

I. General information

NPI: 1750612578
Provider Name (Legal Business Name): BIJI JIJU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 W PIONEER DR SUITE 100
IRVING TX
75061-7308
US

IV. Provider business mailing address

1202 W PIONEER DR SUITE 100
IRVING TX
75061-7308
US

V. Phone/Fax

Practice location:
  • Phone: 972-254-7272
  • Fax:
Mailing address:
  • Phone: 972-254-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209007102
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number826681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: