MEDICARE: MS. STEPHANIE ZACHARIAS GAMEZ III RN

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	163W00000X	Registered Nurse	709872	TX

General Provider Information

NPI Number	:	1457408155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE ZACHARIAS GAMEZ III RN

Provider Business Mailing Address
First Line	:	207 OHIO AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-1722
Country	:	US
Telephone Number	:	361-633-9121
Fax Number	:	361-887-3519

Provider Business Practice Location Address
First Line	:	207 OHIO AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-1722
Country	:	US
Telephone Number	:	361-633-9121
Fax Number	:	361-887-3519

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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