Provider Demographics
NPI:1184791683
Name:EXPRESS NURSING, INC
Entity type:Organization
Organization Name:EXPRESS NURSING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-580-9393
Mailing Address - Street 1:521 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5120
Mailing Address - Country:US
Mailing Address - Phone:432-582-2425
Mailing Address - Fax:432-582-2425
Practice Address - Street 1:4700 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8105
Practice Address - Country:US
Practice Address - Phone:432-580-9393
Practice Address - Fax:432-580-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008527251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5910980001Medicare NSC
TX679327Medicare ID - Type Unspecified