Healthcare Provider Details

I. General information

NPI: 1164918629
Provider Name (Legal Business Name): MELISSA CRAIN DONOSO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 RICHLAND WEST CIR
WACO TX
76712-7919
US

IV. Provider business mailing address

1648 OLD RANCH RD
CHINA SPRING TX
76633-3212
US

V. Phone/Fax

Practice location:
  • Phone: 254-776-8008
  • Fax:
Mailing address:
  • Phone: 254-836-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number818532
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: