=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699304659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TELEMEDICONP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2020
-----------------------------------------------------
Last Update Date | 04/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 S HIGHWAY 183 UNIT 1024
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78646-2439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-991-2990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1024
-----------------------------------------------------
City | LEANDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78646-1024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-991-2990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRUNA LYNN SALAPONG
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 512-969-7747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------