Individual
MARISSA CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-8862
(254) 724-1111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001262813
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP140647
TX
Other
Enumeration date
05/17/2018
Last updated
01/18/2022
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