Organization
WISH MEMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WISH MEMA ACNP (NURSE PRACTITIONER)
(469) 223-9489
Entity
Organization
Contact information
Practice address
1433 WIND DANCER TRL, FORT WORTH, TX 76131-5416
(469) 223-9489
Mailing address
1433 WIND DANCER TRL, FORT WORTH, TX 76131-5416
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
742276
TX
Other
Enumeration date
11/17/2013
Last updated
11/17/2013
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