MEDICARE: EILEEN THERESA DONNELLY 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	363LP2300X	Primary Care Nurse Practitioner	AP135350	TX

General Provider Information

NPI Number	:	1336659010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN THERESA DONNELLY FNP-C

Provider Business Mailing Address
First Line	:	6800 PARK TEN BLVD STE 200S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4293
Country	:	US
Telephone Number	:	210-261-1060
Fax Number	:	210-261-1821

Provider Business Practice Location Address
First Line	:	1954 E HOUSTON ST RM 201
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-2953
Country	:	US
Telephone Number	:	210-419-3076
Fax Number	:	210-261-3741

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

Provider Enumeration Date	:	10/06/2017
Last Update Date	:	07/25/2023

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