MEDICARE: SUSSAN YVETTE SAENZ RN

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	961048	TX

General Provider Information

NPI Number	:	1710447727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSSAN YVETTE SAENZ RN

Provider Business Mailing Address
First Line	:	4104 IRIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1250
Country	:	US
Telephone Number	:	210-364-3103
Fax Number	:

Provider Business Practice Location Address
First Line	:	4104 IRIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1250
Country	:	US
Telephone Number	:	210-364-3103
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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