MEDICARE: ELVA AZENETH CANALES FNP-BC

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	AP126344	TX

General Provider Information

NPI Number	:	1558762328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVA AZENETH CANALES FNP-BC

Provider Business Mailing Address
First Line	:	2706 OKANE ST
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78043-2409
Country	:	US
Telephone Number	:	956-324-3762
Fax Number	:

Provider Business Practice Location Address
First Line	:	3527 JAIME ZAPATA MEMORIAL HWY
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78043-4788
Country	:	US
Telephone Number	:	956-722-5007
Fax Number	:

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

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	09/11/2014

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