Provider Demographics
NPI:1477856227
Name:GRAJEDA, VERONICA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:GRAJEDA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3157
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79923-3157
Mailing Address - Country:US
Mailing Address - Phone:915-577-0051
Mailing Address - Fax:915-577-0054
Practice Address - Street 1:4532 N MESA ST
Practice Address - Street 2:STE 2A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6286
Practice Address - Country:US
Practice Address - Phone:915-544-0326
Practice Address - Fax:915-544-2897
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302816YPS3Medicare PIN