Provider Demographics
NPI:1295420321
Name:BUENROSTRO, NIDIA (A-GNP-C)
Entity type:Individual
Prefix:MRS
First Name:NIDIA
Middle Name:
Last Name:BUENROSTRO
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14018 LITTLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-2264
Mailing Address - Country:US
Mailing Address - Phone:281-683-6542
Mailing Address - Fax:
Practice Address - Street 1:1642 W BAKER RD STE B
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2406
Practice Address - Country:US
Practice Address - Phone:281-422-3000
Practice Address - Fax:281-422-0937
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114378363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health