MEDICARE: MRS. NONA DARLENE ADDISON MENN N.P.

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	163W00000X	Registered Nurse	20986	TX
2	363L00000X	Nurse Practitioner	20986	TX
3	363LP2300X	Primary Care Nurse Practitioner	20986	TX
4	363LW0102X	Women's Health Nurse Practitioner	20986	TX
5	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	20986	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0291	OTHER	TX	TSBNE LPA#
2	20986	OTHER	TX	TSBNE #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	B0141068	OTHER	TX	DPS REGISTRATION
6	45D1039042	OTHER	TX	CLIA

General Provider Information

NPI Number	:	1376542589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NONA DARLENE ADDISON MENN N.P.

Provider Business Mailing Address
First Line	:	PO BOX 1137
Second Line	:
City	:	ODEM
State	:	TX
Zip	:	78370-1137
Country	:	US
Telephone Number	:	361-438-6502
Fax Number	:	361-368-2574

Provider Business Practice Location Address
First Line	:	301 S SAN PATRICIO ST
Second Line	:	SUITE # C
City	:	SINTON
State	:	TX
Zip	:	78387-2432
Country	:	US
Telephone Number	:	361-438-6502
Fax Number	:	361-368-2574

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/07/2023

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Directions to “ MRS. NONA DARLENE ADDISON MENN N.P.” Practice Location

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