=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174049134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE RAE SVOBODA PAWELEK FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2017
-----------------------------------------------------
Last Update Date | 01/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4900 HARRY HINES BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-7719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-590-5524
-----------------------------------------------------
Fax | 214-590-6950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4900 HARRY HINES BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-7719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-590-5524
-----------------------------------------------------
Fax | 214-590-6950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP134304
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------