MEDICARE: PROVIDER PLUS LLC

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	364SG0600X	Gerontology Clinical Nurse Specialist	513451	TX

General Provider Information

NPI Number	:	1548318249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDER PLUS LLC

Provider Business Mailing Address
First Line	:	3723 WILLOW SPRINGS DR
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-4787
Country	:	US
Telephone Number	:	832-264-2133
Fax Number	:	281-485-9817

Provider Business Practice Location Address
First Line	:	3723 WILLOW SPRINGS DR
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-4787
Country	:	US
Telephone Number	:	832-264-2133
Fax Number	:	281-485-9817

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON F MARSHALL
Credential	:	GNP
Telephone Number	:	832-878-1377

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2020

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