=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619684115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERA'S CABINET LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2022
-----------------------------------------------------
Last Update Date | 11/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2518 LANCE LN
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-6114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-240-7386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2518 LANCE LN
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-6114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-240-7386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SHERMIKA DACHELL MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 346-240-7386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------