MEDICARE: DR. VIRGINIA NEAL PHD, 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	103T00000X	Psychologist	24933	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	507763	TX

General Provider Information

NPI Number	:	1174740351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA NEAL PHD, NP

Provider Business Mailing Address
First Line	:	1475 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4109
Country	:	US
Telephone Number	:	214-522-4640
Fax Number	:	214-522-4650

Provider Business Practice Location Address
First Line	:	1475 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4109
Country	:	US
Telephone Number	:	972-248-2299
Fax Number	:	972-248-2012

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	11/04/2009

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