Basic Information
Provider Information
NPI: 1497481592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAENZ
FirstName: MARY
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22
Address2:  
City: YANCEY
State: TX
PostalCode: 788860022
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 8403 SH 151 STE 108
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782452055
CountryCode: US
TelephoneNumber: 2109984790
FaxNumber: 2109984791
Other Information
ProviderEnumerationDate: 07/29/2022
LastUpdateDate: 09/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1087849TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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