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General NPI Number Information
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NPI Number | 1447680178
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Entity Type | Organization
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Legal Business Name | EL SHADDAI FAMILY CLINIC LLC
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 1740 W VIRGINIA ST STE 400
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City | MCKINNEY
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State | TX
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Zip | 75069-7864
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Country | US
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Telephone | 469-252-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 W VIRGINIA ST STE 400
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City | MCKINNEY
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State | TX
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Zip | 75069-7864
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Country | US
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Telephone | 469-252-0101
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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 | BEENA PAUL
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Credential | NP-C
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Telephone | 469-252-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 733997
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License Number State | TX
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