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General NPI Number Information
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NPI Number | 1760953574
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Entity Type | Organization
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Legal Business Name | RESTORE WELLNESS PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 4601 BUFFALO GAP RD STE C1
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City | ABILENE
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State | TX
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Zip | 79606-3363
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Country | US
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Telephone | 325-829-1185
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 BUFFALO GAP RD STE C1
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City | ABILENE
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State | TX
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Zip | 79606-3363
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Country | US
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Telephone | 325-829-1185
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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 | MS. PATRICIA MUNOZ TRUEBLOOD
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Credential | NP-C
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Telephone | 325-829-1185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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