MEDICARE: MRS. ELIZABETH ANN MUNSE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA01403	TX

General Provider Information

NPI Number	:	1134468036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN MUNSE PA-C

Provider Business Mailing Address
First Line	:	3504 LAKEBROOK DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7520
Country	:	US
Telephone Number	:	972-403-1349
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 LAKEBROOK DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7520
Country	:	US
Telephone Number	:	972-403-1349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	02/12/2013

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