Basic Information
| Provider Information | |||||||||
| NPI: | 1417283748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTRELL | ||||||||
| FirstName: | VENETIA | ||||||||
| MiddleName: | GALE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6688 N CENTRAL EXPY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752063914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143689600 | ||||||||
| FaxNumber: | 2147646660 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 NAVARRO ST | ||||||||
| Address2: | SUITE1220 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782052516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105793036 | ||||||||
| FaxNumber: | 2105878167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2009 | ||||||||
| LastUpdateDate: | 10/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 690016 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.