Healthcare Provider Details

I. General information

NPI: 1477289486
Provider Name (Legal Business Name): LORAINE NUNEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 US HIGHWAY 60
PANHANDLE TX
79068-7200
US

IV. Provider business mailing address

PO BOX 10
PANHANDLE TX
79068-0010
US

V. Phone/Fax

Practice location:
  • Phone: 806-532-2273
  • Fax:
Mailing address:
  • Phone: 806-532-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1088712
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: