=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851057947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA ANNABEL PEREZ NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2021
-----------------------------------------------------
Last Update Date | 11/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 305 E 3RD ST
-----------------------------------------------------
City | ALICE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78332-4705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-664-9353
-----------------------------------------------------
Fax | 361-668-1630
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 289
-----------------------------------------------------
City | ALICE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78333-0289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-664-9353
-----------------------------------------------------
Fax | 361-668-1830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1058473
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------