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General NPI Number Information
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NPI Number | 1437742996
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Entity Type | Individual
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Provider Name | PEM REAINTHONG ACNP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2021
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | METHODIST CHARLTON MEDICAL CENTER 3500 WEST WHEATLAND RD
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City | DALLAS
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State | TX
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Zip | 75237
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Country | US
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Telephone | 682-225-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 1218 PLATTE DR
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City | MANSFIELD
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State | TX
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Zip | 76063-6376
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Country | US
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Telephone | 682-225-5222
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1028615
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License Number State | TX
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