Individual
MIMI SONG IDICULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6161 N STATE HIGHWAY 161, IRVING, TX 75038-2220
(972) 258-7499
(972) 257-0897
Mailing address
6161 N STATE HIGHWAY 161, IRVING, TX 75038-2220
(972) 258-7499
(972) 257-0897
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
10049
TX
363L00000X
Nurse Practitioner
Primary
AP137449
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP137449
NURSE PRACTITIONER
TX
Enumeration date
08/20/2007
Last updated
07/13/2021
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