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General NPI Number Information
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NPI Number | 1427432962
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Entity Type | Organization
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Legal Business Name | ELEVATE SENIORS
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 1452 HUGHES RD
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City | GRAPEVINE
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State | TX
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Zip | 76051-7366
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Country | US
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Telephone | 817-873-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 406 CLAYTON ST
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-3322
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Country | US
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Telephone | 214-558-8730
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. DEBORAH RUTH LANIER
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Credential | NP
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Telephone | 214-558-8730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 236933
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License Number State | TX
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