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General NPI Number Information
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NPI Number | 1184673436
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Entity Type | Individual
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Provider Name | MARY THERESE MEYERS-MARQUARDT APRN, BC, ANP
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Gender | Female
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 402 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5247
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Country | US
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Telephone | 575-637-7000
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Fax | 575-637-7019
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Provider Business Mailing Address
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Address Line | 2215 NASHVILLE AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1105
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Country | US
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Telephone | 806-725-5844
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Fax | 806-723-6532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 256947
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | CNP-02624
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License Number State | NM
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