Provider Demographics
NPI:1063185924
Name:SPLENDID CEDAR HEALTHCARE PLLC
Entity type:Organization
Organization Name:SPLENDID CEDAR HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:ISAH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:214-716-9606
Mailing Address - Street 1:1101 E ARAPAHO RD STE 140
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2352
Mailing Address - Country:US
Mailing Address - Phone:469-592-9371
Mailing Address - Fax:469-519-4945
Practice Address - Street 1:1101 E ARAPAHO RD STE 140
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2352
Practice Address - Country:US
Practice Address - Phone:469-592-9371
Practice Address - Fax:469-519-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4320061Medicaid