Healthcare Provider Details

I. General information

NPI: 1750628848
Provider Name (Legal Business Name): CONNIE LOOP RNFA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 MARSH LN
PLANO TX
75093-8497
US

IV. Provider business mailing address

PO BOX 740383
DALLAS TX
75374-0383
US

V. Phone/Fax

Practice location:
  • Phone: 281-463-6309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. CONNIE LOOP
Title or Position: AUTHORIZED OFFICIAL
Credential: RNFA
Phone: 281-463-6309