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General NPI Number Information
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NPI Number | 1548318249
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Entity Type | Organization
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Legal Business Name | PROVIDER PLUS LLC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3723 WILLOW SPRINGS DR
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City | MANVEL
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State | TX
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Zip | 77578-4787
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Country | US
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Telephone | 832-264-2133
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Fax | 281-485-9817
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Provider Business Mailing Address
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Address Line | 3723 WILLOW SPRINGS DR
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City | MANVEL
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State | TX
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Zip | 77578-4787
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Country | US
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Telephone | 832-264-2133
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Fax | 281-485-9817
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Authorized Official
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Title or Position | OWNER
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Name | SHARON F MARSHALL
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Credential | GNP
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Telephone | 832-878-1377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 513451
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License Number State | TX
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