Provider Demographics
NPI:1447750021
Name:BOTELLO, MEREYA (RN)
Entity Type:Individual
Prefix:
First Name:MEREYA
Middle Name:
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 DON LONG RD
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-7014
Mailing Address - Country:US
Mailing Address - Phone:903-930-9908
Mailing Address - Fax:
Practice Address - Street 1:234 DON LONG RD
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-7014
Practice Address - Country:US
Practice Address - Phone:903-930-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX939285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse