Provider Demographics
NPI:1639283104
Name:ALBERS, MITZI
Entity Type:Individual
Prefix:MRS
First Name:MITZI
Middle Name:
Last Name:ALBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N CARROLL AVE STE 2000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6607
Mailing Address - Country:US
Mailing Address - Phone:214-824-7744
Mailing Address - Fax:214-853-4644
Practice Address - Street 1:1015 N CARROLL AVE STE 2000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6607
Practice Address - Country:US
Practice Address - Phone:214-824-7744
Practice Address - Fax:214-853-4644
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02766363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85N406Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER