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NPI Code Detail

MEDICARE: MS. MARY ROFF MCLAUD FNP

MEDICARE: MS. MARY ROFF MCLAUD FNP
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
1363LF0000XFamily Nurse Practitioner04824TX

General Provider Information

NPI Number : 1659793966
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ROFF MCLAUD FNP
Provider Business Mailing Address
First Line : 3900 JUNIUS ST STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75246-1602
Country : US
Telephone Number : 214-521-5191
Fax Number :
Provider Business Practice Location Address
First Line : 4922 SPRING AVE
Second Line :
City : DALLAS
State : TX
Zip : 75210-1359
Country : US
Telephone Number : 214-421-7848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2014
Last Update Date : 11/30/2022

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