Healthcare Provider Details

I. General information

NPI: 1467062174
Provider Name (Legal Business Name): BONNIE RODRIGUEZ MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 ED SCHMIDT BLVD STE 140
HUTTO TX
78634-5586
US

IV. Provider business mailing address

205 E UNIVERSITY AVE STE 200
GEORGETOWN TX
78626-6821
US

V. Phone/Fax

Practice location:
  • Phone: 877-800-5722
  • Fax:
Mailing address:
  • Phone: 512-994-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1007564
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: