Provider Demographics
NPI:1942775986
Name:MUNOZ, EDNA (CPNP)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP
Mailing Address - Street 1:2406 EMMETT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-5415
Mailing Address - Country:US
Mailing Address - Phone:469-776-8669
Mailing Address - Fax:
Practice Address - Street 1:2406 EMMETT ST STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-5415
Practice Address - Country:US
Practice Address - Phone:469-776-8669
Practice Address - Fax:833-357-1698
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138553363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP138553OtherPEDIATRIC NURSE PRACTITIONER