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General NPI Number Information
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NPI Number | 1073378915
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Entity Type | Organization
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Legal Business Name | PROSPECT PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 670 W ARAPAHO RD STE 4
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City | RICHARDSON
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State | TX
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Zip | 75080-4213
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Country | US
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Telephone | 945-333-5481
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6564
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City | MCKINNEY
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State | TX
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Zip | 75071-5115
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. LORENA ELURI
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Credential | AGPCNP-BC
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Telephone | 945-333-5481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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