MEDICARE: GRACE MEYER 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	913734	TX

General Provider Information

NPI Number	:	1275026817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MEYER RN

Provider Business Mailing Address
First Line	:	6724 AVALON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3703
Country	:	US
Telephone Number	:	817-718-4365
Fax Number	:

Provider Business Practice Location Address
First Line	:	8820 SOUTHWESTERN BLVD APT 911
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-2816
Country	:	US
Telephone Number	:	817-718-4365
Fax Number	:

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

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	06/08/2018

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Directions to “ GRACE MEYER RN” Practice Location

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