Provider Demographics
NPI:1093194979
Name:NODENS,LLC
Entity Type:Organization
Organization Name:NODENS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED SURGICAL FIRST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA/CST
Authorized Official - Phone:806-535-9197
Mailing Address - Street 1:4132 HEIRSHIP CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4966
Mailing Address - Country:US
Mailing Address - Phone:806-535-9197
Mailing Address - Fax:817-337-3032
Practice Address - Street 1:4132 HEIRSHIP CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4966
Practice Address - Country:US
Practice Address - Phone:806-535-9197
Practice Address - Fax:817-337-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-25
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty