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General NPI Number Information
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NPI Number | 1285999680
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Entity Type | Organization
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Legal Business Name | LITTLE WAYS HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 2621 W TRENTON RD
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City | EDINBURG
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State | TX
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Zip | 78539-3432
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Country | US
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Telephone | 956-627-1197
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Fax | 956-672-2071
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Provider Business Mailing Address
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Address Line | 2621 W TRENTON RD
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City | EDINBURG
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State | TX
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Zip | 78539-3432
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Country | US
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Telephone | 956-627-1197
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Fax | 956-672-2071
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MARTA PEREZ
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Credential | MSN, FNP-BC
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Telephone | 956-627-1197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 712010
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License Number State | TX
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