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NPI Code Detail

MEDICARE: JOHNNIE MAE IRELAND WHNP-BC

MEDICARE: JOHNNIE MAE IRELAND WHNP-BC
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
1363LW0102XWomen's Health Nurse Practitioner547683TX

General Provider Information

NPI Number : 1497961494
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNIE MAE IRELAND WHNP-BC
Provider Business Mailing Address
First Line : 948 E MULKEY ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-6547
Country : US
Telephone Number : 817-422-8358
Fax Number : 817-257-7279
Provider Business Practice Location Address
First Line : 1919 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1358
Country : US
Telephone Number : 817-332-7722
Fax Number : 817-900-8675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 03/30/2021

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