=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144866039
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONDRA MCFADDEN APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2019
-----------------------------------------------------
Last Update Date | 11/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4055 VALLEY VIEW LN STE 400
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-5071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 622-230-1428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3656 DURHAM DR
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44203-6353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-208-9613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.024730
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------