Provider Demographics
NPI:1417978891
Name:MEDVEREC, MARIJETA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIJETA
Middle Name:
Last Name:MEDVEREC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIJETA
Other - Middle Name:
Other - Last Name:KAUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 GREENLEAF DR
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522
Mailing Address - Country:US
Mailing Address - Phone:254-542-7501
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:CARL R. DARNALL ARMY MEDICAL CENTER
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01855363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical