Provider Demographics
NPI:1093391807
Name:VARISCO, MADISON KATHRYN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KATHRYN
Last Name:VARISCO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W BAY AREA BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4042
Mailing Address - Country:US
Mailing Address - Phone:281-332-3001
Mailing Address - Fax:281-332-3005
Practice Address - Street 1:711 W BAY AREA BLVD STE 602
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4042
Practice Address - Country:US
Practice Address - Phone:281-332-3001
Practice Address - Fax:281-332-3005
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1032222363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty