Doctor Name: | MARY DUTCHOVER |
NPI Number: | 1154730166 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | AP125894 |
Business Practice Address: | 910 James Bowie Dr New Boston, TX - 755702335 |
Business Phone Number: | 9036145950 |
Business Fax Number: | 9036145950 |
Mailing Address: | 919 Hidden Rdg, IRVING |
State: | TX |
Postal Code: | 750383813 |
Phone Number: | 4692822711 |
Fax Number: | 4692822609 |
NPI Enumeration Date: | 08/05/2014 |
NPI Last Update Date: | 11/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP125894 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |