Individual provider · Type 1 NPI
Prajnawati Wibowo, NP
Psychiatric/Mental Health Nurse Practitioner · Dallas, TX
NPI number
1760959696
Active
Practice location
5301 Alpha Rd Ste 80-3
Dallas, TX 75240-4355
Fax (682) 267-4840
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | AP139122 (TX) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | AP139122 (TX) |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 95034910 (CA) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
Another provider at this address
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About NPI 1760959696
Prajnawati Wibowo, NP's National Provider Identifier is 1760959696, issued on Oct 29, 2018. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Dallas, TX. The record was last updated on Oct 27, 2025.