Alice Place Medical Care Services
Nurse Practitioner, Family in Grand Prairie, TX. Organization (NPI-2).
NPI number1710654900
StatusActive
Last updated in NPPESDec 28, 2021
Details
- NPI
- 1710654900
- Entity type
- Organization (NPI-2)
- Legal business name
- Alice Place Medical Care Services
- Organization subpart
- No
- Enumeration date
- Aug 25, 2021
- Certification date
- Dec 28, 2021
- Last updated
- Dec 28, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
| 251S00000X | Community/Behavioral Health | – | – |
Practice location
2719 La Jolla BlvdGrand Prairie, TX 75054-0299
Phone 469-756-7021 · Fax 469-502-3622
Mailing address
2719 La Jolla BlvdGrand Prairie, TX 75054-0299
Phone 469-756-7021 · Fax 469-502-3622
Authorized official
Monnie E Adereti
Ceo
4697567021
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