=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891468898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EBONY MIDCALF NP & COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2021
-----------------------------------------------------
Last Update Date | 07/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7555 WARREN PKWY
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-4145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-596-4612
-----------------------------------------------------
Fax | 888-727-0593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7555 WARREN PKWY
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-4145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-596-4612
-----------------------------------------------------
Fax | 888-727-0593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EBONY N MIDCALF
-----------------------------------------------------
Credential | MSN
-----------------------------------------------------
Telephone | 228-596-4612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------