Healthcare Provider Details

I. General information

NPI: 1083177299
Provider Name (Legal Business Name): MICHELLE MARANON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SAWDUST RD
SPRING TX
77380-2272
US

IV. Provider business mailing address

13215 TERRALYN WAY
SUGAR LAND TX
77478-6059
US

V. Phone/Fax

Practice location:
  • Phone: 833-423-7334
  • Fax:
Mailing address:
  • Phone: 832-859-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number855019
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: