Provider Demographics
NPI:1750403218
Name:FANER, MARIA LUISA (FNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUISA
Last Name:FANER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 CASPER RDG
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8130
Mailing Address - Country:US
Mailing Address - Phone:915-833-8154
Mailing Address - Fax:
Practice Address - Street 1:2300 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-2240
Practice Address - Country:US
Practice Address - Phone:915-562-3444
Practice Address - Fax:915-834-3772
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504888363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO82N4434Medicaid
TXS75492Medicare UPIN
TXPO82N4434Medicaid