MEDICARE: MARY JOYCE PALECEK CFNP

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	R48132	NM
2	363LF0000X	Family Nurse Practitioner	753449	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	632791YNSX	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8JA962	OTHER	TX	BCBS
3	P01999119	OTHER	TX	MCRR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801806526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JOYCE PALECEK CFNP

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 S MAIN ST
Second Line	:
City	:	LINDALE
State	:	TX
Zip	:	75771-7727
Country	:	US
Telephone Number	:	903-882-0991
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	04/27/2018

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