Basic Information
| Provider Information | |||||||||
| NPI: | 1477937597 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHCARE ASSOCIATES OF IRVING, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 COTTONWOOD LN | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722587499 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1110 COTTONWOOD LN | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722587499 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2015 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | LIESVELD | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 9722587499 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | AP128468 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.