MEDICARE: MS. LIDIA MUNOZ LVN

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	164W00000X	Licensed Practical Nurse	184961	TX

General Provider Information

NPI Number	:	1073949426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LIDIA MUNOZ LVN

Provider Business Mailing Address
First Line	:	1012 SILVER SPUR LN
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76179-2328
Country	:	US
Telephone Number	:	817-770-2410
Fax Number	:	817-386-0921

Provider Business Practice Location Address
First Line	:	1012 SILVER SPUR LN
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76179-2328
Country	:	US
Telephone Number	:	817-770-2410
Fax Number	:	817-386-0921

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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