Provider Demographics
NPI:1376595983
Name:ESCALANTE, MAUDE L (RN,FNP-C)
Entity Type:Individual
Prefix:
First Name:MAUDE
Middle Name:L
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:RN,FNP-C
Other - Prefix:
Other - First Name:MAUDE
Other - Middle Name:L
Other - Last Name:DURBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP-C
Mailing Address - Street 1:731 N WALNUT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-7927
Mailing Address - Country:US
Mailing Address - Phone:830-609-0080
Mailing Address - Fax:830-629-0416
Practice Address - Street 1:731 N WALNUT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7927
Practice Address - Country:US
Practice Address - Phone:830-609-0080
Practice Address - Fax:830-629-0416
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX269689YLPSOtherWELLMED MEDICAL GROUP PA
TX174725501Medicaid
TX8D7504Medicare ID - Type UnspecifiedMEDICARE
TX174725501Medicaid