MEDICARE: MARK DINNING APRN

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	163WE0003X	Emergency Registered Nurse	880527	TX

General Provider Information

NPI Number	:	1689137150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK DINNING APRN

Provider Business Mailing Address
First Line	:	15674 RIDGE ROCK RD
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378
Country	:	US
Telephone Number	:	936-230-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 BERTNER AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3901
Country	:	US
Telephone Number	:	713-500-3087
Fax Number	:

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

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	05/07/2023

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