Basic Information
| Provider Information | |||||||||
| NPI: | 1740556042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGRA | ||||||||
| FirstName: | AMRITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 570 ROCKINGHAM DR | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750638053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729003417 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2350 N STEMMONS FWY STE F-2400 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752072700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694887100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2012 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Q5875 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | Q5875 | 01 | TX | PEDIATRICS | OTHER |