Individual
MARC PROVENZANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
493 N MAIN ST, GROVETON, TX 75845-2498
(281) 515-8349
Mailing address
PO BOX 395, GROVETON, TX 75845-0395
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1119122
TX
Other
Enumeration date
09/22/2023
Last updated
10/08/2024
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