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General NPI Number Information
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NPI Number | 1811303845
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Entity Type | Organization
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Legal Business Name | LKW RNFA
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 10830 N CENTRAL EXPY 120
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City | DALLAS
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State | TX
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Zip | 75231-1050
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Country | US
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Telephone | 214-378-9898
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Fax | 214-378-9888
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Provider Business Mailing Address
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Address Line | 10830 N CENTRAL EXPY 120
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City | DALLAS
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State | TX
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Zip | 75231-1050
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Country | US
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Telephone | 214-378-9898
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Fax | 214-378-9888
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA K WEAVER
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Credential | RNFA
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Telephone | 214-378-9898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 773834
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License Number State | TX
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