Provider Demographics
NPI:1033870456
Name:IMPE, MARIE CHARISSE (NP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CHARISSE
Last Name:IMPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 SARATOGA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4252
Mailing Address - Country:US
Mailing Address - Phone:361-696-6200
Mailing Address - Fax:
Practice Address - Street 1:5802 SARATOGA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4252
Practice Address - Country:US
Practice Address - Phone:361-696-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF11200688207RR0500X
TX1026508207RR0500X, 363L00000X
TX363L00000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner