MEDICARE: MARIEZEN V BIBAL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP117118	TX

General Provider Information

NPI Number	:	1063667442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIEZEN V BIBAL FNP

Provider Business Mailing Address
First Line	:	12377 MERIT DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3126
Country	:	US
Telephone Number	:	972-597-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 HILLCROFT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4770
Country	:	US
Telephone Number	:	713-988-6677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	03/21/2023

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