Provider Demographics
NPI:1184673436
Name:MEYERS-MARQUARDT, MARY THERESE (APRN, BC, ANP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESE
Last Name:MEYERS-MARQUARDT
Suffix:
Gender:F
Credentials:APRN, BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:402 W COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5247
Practice Address - Country:US
Practice Address - Phone:575-637-7000
Practice Address - Fax:575-637-7019
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256947363L00000X
NMCNP-02624363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y5552OtherTEXAS BCBS
TX200646201Medicaid
NM519408YYH0OtherMEDICARE
NM519408YYH0OtherMEDICARE
TX8Y5552OtherTEXAS BCBS
TX8L7800Medicare PIN