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NPI Code Detail

MEDICARE: ELIZABETH PRINCE LVN

MEDICARE: ELIZABETH PRINCE LVN
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
1261QP0905XState or Local Public Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1307268OTHERTXLISCENSE NUMBER

General Provider Information

NPI Number : 1669861852
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH PRINCE LVN
Provider Business Mailing Address
First Line : 929 EDNA DR
Second Line :
City : EVERMAN
State : TX
Zip : 76140-3705
Country : US
Telephone Number : 817-480-7973
Fax Number :
Provider Business Practice Location Address
First Line : 536 W RANDOL MILL RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-5738
Country : US
Telephone Number : 817-321-4716
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2015
Last Update Date : 01/12/2015

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