MEDICARE: MISS MARIA DE LOURDES CAMACHO

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	363LF0000X	Family Nurse Practitioner	33828	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP145529	TX

General Provider Information

NPI Number	:	1477188308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA DE LOURDES CAMACHO

Provider Business Mailing Address
First Line	:	5215 AUDREY ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-3202
Country	:	US
Telephone Number	:	972-679-7942
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 W NORTHWEST HWY STE 189
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-4972
Country	:	US
Telephone Number	:	972-679-7942
Fax Number	:

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

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	03/22/2024

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Directions to “ MISS MARIA DE LOURDES CAMACHO ” Practice Location

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