Organization
ALICE PLACE MEDICAL CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MONNIE E ADERETI FNP (CEO)
(469) 756-7021
Entity
Organization
Contact information
Practice address
2719 LA JOLLA BLVD, GRAND PRAIRIE, TX 75054-0299
(469) 756-7021
(469) 502-3622
Mailing address
2719 LA JOLLA BLVD, GRAND PRAIRIE, TX 75054-0299
(469) 756-7021
(469) 502-3622
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370763001
—
TX
Enumeration date
08/25/2021
Last updated
12/28/2021
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