MEDICARE: DE NOVO INC

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	363LA2200X	Adult Health Nurse Practitioner	552592	TX

General Provider Information

NPI Number	:	1871899518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DE NOVO INC

Provider Business Mailing Address
First Line	:	2603 OAK LAWN AVE
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75219-4021
Country	:	US
Telephone Number	:	888-699-7126
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 OAK LAWN AVE
Second Line	:	STE 100
City	:	DALLAS
State	:	TX
Zip	:	75219-4021
Country	:	US
Telephone Number	:	888-699-7126
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN E STEVENS
Credential	:	NP
Telephone Number	:	888-699-7126

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	01/27/2011

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Directions to “DE NOVO INC ” Practice Location

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