Healthcare Provider Details

I. General information

NPI: 1831900091
Provider Name (Legal Business Name): PEACE DZANYIKPOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 CHERRY DR
LITTLE ELM TX
75068-5668
US

IV. Provider business mailing address

2528 CHERRY DR
LITTLE ELM TX
75068-5668
US

V. Phone/Fax

Practice location:
  • Phone: 972-827-5709
  • Fax:
Mailing address:
  • Phone: 972-827-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1142203
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: