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NPI Code Detail

MEDICARE: DR. ELIZABETH GRACE ENNIS AU.D.

MEDICARE: DR. ELIZABETH GRACE ENNIS AU.D.
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
1231H00000XAudiologist81506TX

General Provider Information

NPI Number : 1669163879
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH GRACE ENNIS AU.D.
Provider Business Mailing Address
First Line : 4513 SALERNO CIR
Second Line :
City : PLANO
State : TX
Zip : 75093-7030
Country : US
Telephone Number : 469-536-1525
Fax Number :
Provider Business Practice Location Address
First Line : 5751 EDWARDS RANCH RD STE 200
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4152
Country : US
Telephone Number : 817-332-8848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2023
Last Update Date : 06/20/2023

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