Organization
DFW SUPER GROUP I LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANA S. RALSTON F.N.P. (MANAGER)
(214) 632-3514
Entity
Organization
Contact information
Practice address
3020 LEGACY DR, STE. 100-399, PLANO, TX 75023-8322
(214) 632-3514
Mailing address
PO BOX 835850, RICHARDSON, TX 75083-5850
(972) 680-1577
(972) 690-9834
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/11/2006
Last updated
02/20/2008
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