1417283748 NPI number — MRS. VENETIA GALE CANTRELL FNP

Table of content: MRS. VENETIA GALE CANTRELL FNP (NPI 1417283748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417283748 NPI number — MRS. VENETIA GALE CANTRELL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTRELL
Provider First Name:
VENETIA
Provider Middle Name:
GALE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417283748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6688 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-3914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-368-9600
Provider Business Mailing Address Fax Number:
214-764-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 NAVARRO ST
Provider Second Line Business Practice Location Address:
SUITE1220
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78205-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-579-3036
Provider Business Practice Location Address Fax Number:
210-587-8167
Provider Enumeration Date:
10/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  690016 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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