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General NPI Number Information
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NPI Number | 1265819916
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Entity Type | Individual
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Provider Name | ETTA LEORA HAMMIE LVN
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 2327 OAKLAND BLVD
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City | FT. WORTH
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State | TX
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Zip | 76011
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Country | US
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Telephone | 817-984-1496
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Fax | 817-984-1497
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Provider Business Mailing Address
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Address Line | 1012 SKYLINE DR APT 1412
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City | ARLINGTON
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State | TX
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Zip | 76011-1383
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Country | US
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Telephone | 817-298-9792
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Fax | 817-617-3479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 171393
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License Number State | TX
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