MEDICARE: SEMPER LUMINE TANAMOR SOJOR FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP142972	TX

General Provider Information

NPI Number	:	1003457284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEMPER LUMINE TANAMOR SOJOR FNP-C

Provider Business Mailing Address
First Line	:	1018 BEECH AVE STE 100
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-4547
Country	:	US
Telephone Number	:	956-800-5171
Fax Number	:	956-800-5178

Provider Business Practice Location Address
First Line	:	1018 BEECH AVE STE 100
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-4547
Country	:	US
Telephone Number	:	956-800-5171
Fax Number	:	956-800-5178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	10/03/2019

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