Provider Demographics
NPI:1790456531
Name:BASAL, RIMA (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:BASAL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 ELAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-7368
Mailing Address - Country:US
Mailing Address - Phone:214-397-9444
Mailing Address - Fax:
Practice Address - Street 1:6520 N PRESIDENT GEORGE BUSH HWY STE 100
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-3925
Practice Address - Country:US
Practice Address - Phone:972-532-9967
Practice Address - Fax:972-495-2287
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047216208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics