MEDICARE: MIA PAINTER NP-C

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	NP 707161	TX

General Provider Information

NPI Number	:	1952608770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA PAINTER NP-C

Provider Business Mailing Address
First Line	:	2406 HUNTER RD
Second Line	:	SUITE 106
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-5255
Country	:	US
Telephone Number	:	512-396-7686
Fax Number	:	512-396-8006

Provider Business Practice Location Address
First Line	:	2406 HUNTER RD
Second Line	:	SUITE 106
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-5255
Country	:	US
Telephone Number	:	512-396-7686
Fax Number	:	512-396-8006

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	02/14/2011

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Directions to “ MIA PAINTER NP-C” Practice Location

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