Provider Demographics
NPI:1093466310
Name:QUEHL, MARISSA BRIANNE (PA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:BRIANNE
Last Name:QUEHL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SUNSET RIDGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0007
Mailing Address - Country:US
Mailing Address - Phone:972-772-5450
Mailing Address - Fax:
Practice Address - Street 1:2701 SUNSET RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-0007
Practice Address - Country:US
Practice Address - Phone:972-772-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant