MEDICARE: MRS. CLARA MAINOO

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	163WH0200X	Home Health Registered Nurse	701467	TX

General Provider Information

NPI Number	:	1285030197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLARA MAINOO

Provider Business Mailing Address
First Line	:	2466 RIO GRANDE DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7853
Country	:	US
Telephone Number	:	214-542-1038
Fax Number	:

Provider Business Practice Location Address
First Line	:	2466 RIO GRANDE DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7853
Country	:	US
Telephone Number	:	214-542-1038
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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