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General NPI Number Information
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NPI Number | 1295420321
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Entity Type | Individual
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Provider Name | NIDIA BUENROSTRO A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1642 W BAKER RD STE B
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City | BAYTOWN
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State | TX
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Zip | 77521-2406
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Country | US
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Telephone | 281-422-3000
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Fax | 281-422-0937
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Provider Business Mailing Address
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Address Line | 14018 LITTLE RIVER DR
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City | BAYTOWN
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State | TX
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Zip | 77523-2264
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Country | US
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Telephone | 281-683-6542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1114378
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License Number State | TX
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