Provider Demographics
NPI:1265778260
Name:DEMAIO, ANN SETIAN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:SETIAN
Last Name:DEMAIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76577-0159
Mailing Address - Country:US
Mailing Address - Phone:512-375-6968
Mailing Address - Fax:
Practice Address - Street 1:1889 COUNTY ROAD 450
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:TX
Practice Address - Zip Code:76577-5206
Practice Address - Country:US
Practice Address - Phone:714-392-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396991163WN0002X
TX828491163WN0002X, 363LN0000X
ARA003787163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care