Healthcare Provider Details

I. General information

NPI: 1326820820
Provider Name (Legal Business Name): LYUDMILA MOKROUZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 LEGACY DR
PLANO TX
75024-3399
US

IV. Provider business mailing address

3801 BLANCO CREEK TRL
MCKINNEY TX
75070-6134
US

V. Phone/Fax

Practice location:
  • Phone: 718-683-6000
  • Fax:
Mailing address:
  • Phone: 718-683-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1134395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: