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General NPI Number Information
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NPI Number | 1821532565
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Entity Type | Organization
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Legal Business Name | EQUILIBRE CLINIC LLC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 6025 METROPOLITAN DR STE 210
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City | BEAUMONT
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State | TX
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Zip | 77706-2409
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Country | US
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Telephone | 713-588-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 6025 METROPOLITAN DR STE 210
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City | BEAUMONT
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State | TX
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Zip | 77706-2409
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Country | US
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Telephone | 713-588-9302
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MRS. SIOBAIN KAY ROGERS
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Credential | MSN, APRN, FNP-C
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Telephone | 713-588-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | AP130283
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License Number State | TX
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