MEDICARE: PHYLLIS NJUE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	9481429	TX

General Provider Information

NPI Number	:	1093211831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS NJUE RN

Provider Business Mailing Address
First Line	:	5445 PRESTON OAKS RD APT 511
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2421
Country	:	US
Telephone Number	:	682-558-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	5445 PRESTON OAKS RD APT 511
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-2421
Country	:	US
Telephone Number	:	682-558-9232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	04/02/2018

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