Provider Demographics
NPI:1225124142
Name:BERNIGER, MARILISE ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARILISE
Middle Name:ANNE
Last Name:BERNIGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARILISE
Other - Middle Name:B
Other - Last Name:MARANCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004002363A00000X
TXPA02861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88N193OtherBCBS (MDACC)
VA1225124142Medicaid
TX202340001 (MDACC)Medicaid
TX970017769OtherRR MEDICARE (MDACC)
P24224Medicare UPIN
VA1225124142Medicaid
TX85N697 (MDACC)Medicare PIN