Provider Demographics
NPI:1871899518
Name:DE NOVO INC
Entity type:Organization
Organization Name:DE NOVO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:888-699-7126
Mailing Address - Street 1:2603 OAK LAWN AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4021
Mailing Address - Country:US
Mailing Address - Phone:888-699-7126
Mailing Address - Fax:
Practice Address - Street 1:2603 OAK LAWN AVE
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4021
Practice Address - Country:US
Practice Address - Phone:888-699-7126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552592363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty