Healthcare Provider Details

I. General information

NPI: 1255831020
Provider Name (Legal Business Name): LUCINDA HARWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2018
Last Update Date: 02/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 DAVIS RD
LIPAN TX
76462-4300
US

IV. Provider business mailing address

1611 DAVIS RD
LIPAN TX
76462-4300
US

V. Phone/Fax

Practice location:
  • Phone: 254-646-2687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number167169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: