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Organization
SUPREME WISDOM FAMILY HEALTH CLINIC INC
Active
Organization
SUPREME WISDOM FAMILY HEALTH CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHALILIAH ALI FNP-C, APRN, BC (PRESIDENT)
(469) 835-3449
Entity
Organization
Contact information
Practice address
455 GOTLAND DR, GRAND PRAIRIE, TX 75052-2570
(469) 831-3149
Mailing address
455 GOTLAND DR, GRAND PRAIRIE, TX 75052-2570
(469) 831-3149
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
682811
TX
Other
Enumeration date
08/26/2011
Last updated
09/15/2011
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