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General NPI Number Information
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NPI Number | 1417038175
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Entity Type | Individual
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Provider Name | AURORA MARY MIGNOSA M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 301 LONDONDERRY DR
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City | WACO
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State | TX
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Zip | 76712-7915
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Country | US
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Telephone | 254-751-4880
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Fax | 254-751-4885
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Provider Business Mailing Address
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Address Line | PO BOX 18962
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City | BELFAST
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State | ME
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Zip | 04915-4084
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Country | US
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Telephone | 800-566-5050
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Fax | 254-537-6869
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2024034855
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M3324
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License Number State | TX
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