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NPI Code Detail

MEDICARE: MARISSA BLANCO LPC, FNP

MEDICARE: MARISSA BLANCO LPC, 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
1101YM0800XMental Health Counselor10875TX
2363LF0000XFamily Nurse Practitioner760444TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386644821
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA BLANCO LPC, FNP
Provider Business Mailing Address
First Line : 1610 5TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79401-2622
Country : US
Telephone Number : 806-765-2611
Fax Number : 806-741-3012
Provider Business Practice Location Address
First Line : 1610 5TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79401-2622
Country : US
Telephone Number : 806-765-2611
Fax Number : 806-741-3012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2005
Last Update Date : 08/13/2024

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Directions to “ MARISSA BLANCO LPC, FNP” Practice Location

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