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General NPI Number Information
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NPI Number | 1023465861
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH CLINIC
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 2140 HIGHWAY 157 N
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City | MANSFIELD
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State | TX
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Zip | 76063-4847
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Country | US
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Telephone | 817-813-8055
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Fax | 817-730-9068
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Provider Business Mailing Address
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Address Line | 2140 HIGHWAY 157 N
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City | MANSFIELD
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State | TX
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Zip | 76063-4847
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Country | US
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Telephone | 817-813-8055
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Fax | 817-730-9068
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LISELOTTE ADDEA-AMOAKO
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Credential | DNP
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Telephone | 817-813-8055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP123379
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License Number State | TX
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