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General NPI Number Information
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NPI Number | 1477462307
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Entity Type | Individual
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Provider Name | MARISSA RENTERIA CLAVETTE CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 09/04/2026
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Last Update Date | 09/04/2026
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Provider Practice Location Address
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Address Line | 1500 COOPER ST
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City | FORT WORTH
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State | TX
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Zip | 76104-2710
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Country | US
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Telephone | 682-885-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 11713 ALDERMOOR CT
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City | CROWLEY
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State | TX
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Zip | 76036-3278
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Country | US
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Telephone |
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Fax |
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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 | 163WP0218X
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Taxonomy Name | Pediatric Oncology Registered Nurse
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License Number | 831909
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License Number State | TX
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