Healthcare Provider Details

I. General information

NPI: 1598447666
Provider Name (Legal Business Name): MARYSSA LYNNE MILLIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 KINGWOOD MEDICAL DR
KINGWOOD TX
77339-6407
US

IV. Provider business mailing address

13735 PLAYA LUCIA CT
HOUSTON TX
77044-1220
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-2080
  • Fax:
Mailing address:
  • Phone: 281-221-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number808831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: