MEDICARE: MARLEE GOLDBACH HIGGINS APRN, PNP-AC

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	163W00000X	Registered Nurse	906352	TX
2	363LP0222X	Critical Care Pediatric Nurse Practitioner	1016742	TX

General Provider Information

NPI Number	:	1578135554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEE GOLDBACH HIGGINS APRN, PNP-AC

Provider Business Mailing Address
First Line	:	1826 SALFORD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-704-5437
Fax Number	:

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

Provider Enumeration Date	:	07/11/2021
Last Update Date	:	07/11/2021

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