Healthcare Provider Details

I. General information

NPI: 1093923500
Provider Name (Legal Business Name): JUANA ALICIA MEJIA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 JAMES ST STE B
WESLACO TX
78596-6654
US

IV. Provider business mailing address

5940 NORTH OLD LA BLANCA
DONNA TX
78537
US

V. Phone/Fax

Practice location:
  • Phone: 956-968-1621
  • Fax: 956-447-0646
Mailing address:
  • Phone: 956-464-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number563534
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: