Healthcare Provider Details

I. General information

NPI: 1770826984
Provider Name (Legal Business Name): LONETTA L POSTELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MATLOCK RD
MANSFIELD TX
76063-9174
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 817-347-8420
  • Fax: 817-347-8495
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT9474
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301103317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: