Provider Demographics
NPI:1083177299
Name:MARANON, MICHELLE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MARANON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 TERRALYN WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-6059
Mailing Address - Country:US
Mailing Address - Phone:832-859-3030
Mailing Address - Fax:
Practice Address - Street 1:130 SAWDUST RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2272
Practice Address - Country:US
Practice Address - Phone:833-423-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX855019163WP0200X
TXAP142388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics