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511 E John Carpenter Fwy Ste 500, Irving, TX 75062-8138 | |
(214) 636-5393 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Nurse Practitioner - Family |
Location | 511 E John Carpenter Fwy Ste 500, Irving, Texas |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1083312086 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | (* (Not Available)) | Secondary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
Provider Name | Diana Iveth Godinez |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1316295249 PECOS PAC ID: 6608139175 Enrollment ID: I20180416000377 |
Mailing Address | Practice Location Address |
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511 E John Carpenter Fwy Ste 500, Irving, TX 75062-8138 Ph: () - | 511 E John Carpenter Fwy Ste 500, Irving, TX 75062-8138 Ph: (214) 636-5393 |