MEDICARE: MICHELLE MALDONADO APRN CPNP

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	363LP0200X	Pediatric Nurse Practitioner	1138276	TX

General Provider Information

NPI Number	:	1861274912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MALDONADO APRN CPNP

Provider Business Mailing Address
First Line	:	10007 PENSIVE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-5802
Country	:	US
Telephone Number	:	214-563-7079
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 WELBORN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3993
Country	:	US
Telephone Number	:	214-559-7785
Fax Number	:

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

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/13/2023

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