Blanco, Marissa

Blanco, Marissa is an individual health care provider with primary practice located at 1318 Broadway , Lubbock TX 79401-3206. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Blanco, Marissa can be contacted via phone (806) 765-2611.

Contact Information

Primary practice address
1318 Broadway Lubbock TX 79401-3206
Phone: (806) 765-2611
Fax: (806) 741-3012
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 10875 Texas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 760444 Texas

Profile Details

NPI number 1386644821
LBN Legal business name Blanco, Marissa
Credentials LPC, FNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2005
Last updated Jul 3rd, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386644821 NPPES
Texas MEDICAID 028736901

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