Healthcare Provider Details

I. General information

NPI: 1265232300
Provider Name (Legal Business Name): DONNA MARIE VAJI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 LEBANON RD
FRISCO TX
75035-8298
US

IV. Provider business mailing address

4770 TEEL PKWY APT 7306
FRISCO TX
75034-2667
US

V. Phone/Fax

Practice location:
  • Phone: 469-764-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL311672
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: