Individual
MARANDA BROOKE ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
2710 SWISS AVE, DALLAS, TX 75204-5900
(214) 821-1599
Mailing address
3610 GILLESPIE ST APT 6, DALLAS, TX 75219-4979
(918) 845-6053
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1212740
TX
Other
Enumeration date
08/21/2025
Last updated
09/11/2025
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