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General NPI Number Information
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NPI Number | 1932078391
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Entity Type | Individual
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Provider Name | LADY JANICE CUSTODIO DUTERTE
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Gender | Female
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 12777 SPRING HILL DR
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City | FRISCO
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State | TX
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Zip | 75035-1644
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Country | US
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Telephone | 917-655-3784
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Fax | 972-472-8881
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Provider Business Mailing Address
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Address Line | 12777 SPRING HILL DR
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City | FRISCO
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State | TX
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Zip | 75035-1644
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Country | US
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Telephone | 917-655-3784
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Fax | 972-472-8881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN1003X
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Taxonomy Name | Nutrition Support Registered Nurse
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License Number | 783146
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 783146
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 783146
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 783146
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 783146
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 783146
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 163WC1600X
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Taxonomy Name | Continuing Education/Staff Development Registered Nurse
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License Number | 783146
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 783146
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License Number State | TX
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