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NPI Code Detail

MEDICARE: MYRNA DOMANSI GRAJO FNP

MEDICARE: MYRNA DOMANSI GRAJO FNP
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
1363LF0000XFamily Nurse Practitioner684775TX

General Provider Information

NPI Number : 1184105009
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRNA DOMANSI GRAJO FNP
Provider Business Mailing Address
First Line : 6506 N 28TH LN
Second Line :
City : MCALLEN
State : TX
Zip : 78504-4207
Country : US
Telephone Number : 956-624-4676
Fax Number :
Provider Business Practice Location Address
First Line : 214 CHAPARRAL BLVD
Second Line :
City : RIO GRANDE CITY
State : TX
Zip : 78582-4605
Country : US
Telephone Number : 956-263-1830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2018
Last Update Date : 08/28/2018

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Directions to “ MYRNA DOMANSI GRAJO FNP” Practice Location

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