Organization Name: | PECAN GROVE HEALTHCARE |
NPI Number: | 1306114277 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REBECCA L LUCAS (OWNER) |
Mailing Address: | 805 W Lampasas St Ennis |
State: | TX US |
Postal Code: | 751194535 |
Phone Number: | 9728759494 |
Fax Number: | 9728780689 |
NPI Enumeration Date: | 12/07/2011 |
NPI Last Update Date: | 12/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 517664 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |