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General NPI Number Information
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NPI Number | 1710510755
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Entity Type | Individual
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Provider Name | MAGNOLIA WOODS
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Gender | Female
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 6130 W PARKER RD
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City | PLANO
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State | TX
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Zip | 75093-7901
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Country | US
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Telephone | 870-413-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 4932 CEDAR BRUSH DR
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City | FORT WORTH
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State | TX
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Zip | 76123-2957
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Country | US
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Telephone | 870-413-0825
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | AP138502
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License Number State | TX
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