MEDICARE: VANESSA L AVRUTIS ARNP

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	743107	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	743107	OTHER	TX	FNP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235217514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA L AVRUTIS ARNP

Provider Business Mailing Address
First Line	:	3301 UNICORN LAKE BOULEVARD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0102
Country	:	US
Telephone Number	:	940-383-1578
Fax Number	:	940-382-0333

Provider Business Practice Location Address
First Line	:	3301 UNICORN LAKE BOULEVARD
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0102
Country	:	US
Telephone Number	:	940-383-1578
Fax Number	:	940-382-0333

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	03/20/2015

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