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General NPI Number Information
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NPI Number | 1851458038
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Entity Type | Organization
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Legal Business Name | CHILDRENS MEDICAL CENTER DALLAS
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1935 MOTOR ST
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City | DALLAS
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State | TX
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Zip | 75235-7701
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Country | US
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Telephone | 214-456-5614
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Fax |
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Provider Business Mailing Address
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Address Line | 5060 WATEKA DR
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City | DALLAS
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State | TX
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Zip | 75209-4825
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Country | US
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Telephone | 214-353-2775
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Fax | 214-456-5071
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. STEPHANIE DETAMORE ATHRE
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Credential | RN, MSN CPNP
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Telephone | 214-456-5614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 630600
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License Number State | TX
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