Basic Information
| Provider Information | |||||||||
| NPI: | 1669495792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HITZFELDER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 W LANCASTER | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173362823 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173368611 | ||||||||
| FaxNumber: | 6823362823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 04/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0008X | E6098 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 120503105 | 05 | TX | MEDICAID | 140442813 | 05 | TX | MEDICAID | 1548230923 | 01 | TX | GROUP NPI NUMBER | OTHER |