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General NPI Number Information
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NPI Number | 1508490517
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Entity Type | Organization
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Legal Business Name | PARACLETE PRIMARY HEALTH CARE SERVICES
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 555 REPUBLIC DR FL 2
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City | PLANO
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State | TX
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Zip | 75074-5481
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Country | US
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Telephone | 469-223-1173
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Fax |
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Provider Business Mailing Address
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Address Line | 3106 JACOB DR
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City | WYLIE
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State | TX
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Zip | 75098-8131
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Country | US
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Telephone | 469-223-1173
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NITAS DURU OHA
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Credential | APRN FNP
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Telephone | 469-223-1173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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