Healthcare Provider Details

I. General information

NPI: 1154730166
Provider Name (Legal Business Name): MARY DUTCHOVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 JAMES BOWIE DR
NEW BOSTON TX
75570-2335
US

IV. Provider business mailing address

919 HIDDEN RDG
IRVING TX
75038-3813
US

V. Phone/Fax

Practice location:
  • Phone: 903-614-5950
  • Fax: 903-614-5950
Mailing address:
  • Phone: 469-282-2711
  • Fax: 469-282-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125894
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: