MEDICARE: MRS. VERONICA GRAJEDA 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
1	363LF0000X	Family Nurse Practitioner	AP119322	TX

General Provider Information

NPI Number	:	1477856227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERONICA GRAJEDA FNP

Provider Business Mailing Address
First Line	:	PO BOX 3157
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79923-3157
Country	:	US
Telephone Number	:	915-577-0051
Fax Number	:	915-577-0054

Provider Business Practice Location Address
First Line	:	4532 N MESA ST
Second Line	:	STE 2A
City	:	EL PASO
State	:	TX
Zip	:	79912-6286
Country	:	US
Telephone Number	:	915-544-0326
Fax Number	:	915-544-2897

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

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	01/20/2017

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