Provider Demographics
NPI:1851029151
Name:BRONAUGH, FAITH
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BRONAUGH
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 1:3911 TREELINE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4166
Mailing Address - Country:US
Mailing Address - Phone:214-395-6151
Mailing Address - Fax:
Practice Address - Street 1:3911 TREELINE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4166
Practice Address - Country:US
Practice Address - Phone:214-395-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX850651243Medicaid