Organization · Type 2 NPI
South Loop 12 Medical Clinic LLC
Family Nurse Practitioner · Dallas, TX
NPI number
1417034745
Active
Practice location
3232 Great Trinity Forest Way, Ste. 102
Dallas, TX 75216-7732
Fax (214) 398-4326
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 528675 (TX) |
Family Nurse Practitioner: Definition to come...
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About NPI 1417034745
South Loop 12 Medical Clinic LLC's National Provider Identifier is 1417034745, issued on Nov 1, 2006. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Dallas, TX. The record was last updated on Oct 9, 2014.