MEDICARE: GRETCHEN LEIGH MCGUIRE

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	363LN0000X	Neonatal Nurse Practitioner	713120	TX

General Provider Information

NPI Number	:	1144582297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN LEIGH MCGUIRE

Provider Business Mailing Address
First Line	:	1185 COLORADO DR
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75167-8195
Country	:	US
Telephone Number	:	972-351-9031
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7708
Country	:	US
Telephone Number	:	214-590-6500
Fax Number	:

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

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	06/14/2012

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