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General NPI Number Information
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NPI Number | 1881035004
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Entity Type | Organization
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Legal Business Name | NEW DAWN SERVICES
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 2300 E RANCIER AVE SUITE 103
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City | KILLEEN
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State | TX
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Zip | 76543-3400
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Country | US
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Telephone | 254-200-2310
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Fax | 254-200-2340
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Provider Business Mailing Address
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Address Line | 2300 E RANCIER AVE SUITE 103
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City | KILLEEN
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State | TX
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Zip | 76543-3400
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Country | US
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Telephone | 254-200-2310
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Fax | 254-200-2340
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Authorized Official
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Title or Position | OWNER
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Name | MRS. POLLY TEEN VICK
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Credential | APRN, FNP-BC
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Telephone | 254-535-6020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 675722
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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