Provider Demographics
NPI:1508618141
Name:PREMIER LIFE CARE
Entity Type:Organization
Organization Name:PREMIER LIFE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-BC, PMHNP-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:BUKUNMI
Authorized Official - Last Name:FREMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-331-4643
Mailing Address - Street 1:6703 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-3171
Mailing Address - Country:US
Mailing Address - Phone:347-331-4643
Mailing Address - Fax:
Practice Address - Street 1:6703 VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-3171
Practice Address - Country:US
Practice Address - Phone:347-331-4643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty