MEDICARE: SONDRA A MACH NP

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	363LF0000X	Family Nurse Practitioner	583401	TX

General Provider Information

NPI Number	:	1174036024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONDRA A MACH NP

Provider Business Mailing Address
First Line	:	3614 CAMP BOWIE BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-3352
Country	:	US
Telephone Number	:	817-870-1873
Fax Number	:

Provider Business Practice Location Address
First Line	:	3614 CAMP BOWIE BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-3352
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	03/25/2019

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