Provider Demographics
NPI:1639517782
Name:NULIFE CLINIC, PA
Entity Type:Organization
Organization Name:NULIFE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-255-5588
Mailing Address - Street 1:4301 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6497
Mailing Address - Country:US
Mailing Address - Phone:972-255-5588
Mailing Address - Fax:
Practice Address - Street 1:4301 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6497
Practice Address - Country:US
Practice Address - Phone:972-255-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NULIFE CLINIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-11
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90-07696258261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty