Individual
MARY MATHAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHCNP
Contact information
Practice address
3320 LIVE OAK ST FL 5, EAST DALLAS WOMEN'S HEALTH CENTER, DALLAS, TX 75204-6109
(214) 266-1200
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
592720
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197049301
—
TX
05
—
197049304
—
TX
05
—
197049305
—
TX
05
—
197049306
—
TX
05
—
197049307
—
TX
05
—
197049308
—
TX
05
—
197049309
—
TX
05
—
197049310
—
TX
01
—
8Y3522
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/21/2006
Last updated
04/06/2009
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