Individual
SANDRA BIALOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3653
Mailing address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1004824
TX
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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