Provider Demographics
NPI:1669861852
Name:PRINCE, ELIZABETH (LVN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 EDNA DR
Mailing Address - Street 2:
Mailing Address - City:EVERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76140-3705
Mailing Address - Country:US
Mailing Address - Phone:817-480-7973
Mailing Address - Fax:
Practice Address - Street 1:536 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5738
Practice Address - Country:US
Practice Address - Phone:817-321-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307268OtherLISCENSE NUMBER