Provider Demographics
NPI:1457681470
Name:RAMOS, MARISOL PACHECO (GNP)
Entity Type:Individual
Prefix:MS
First Name:MARISOL
Middle Name:PACHECO
Last Name:RAMOS
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N GARFIELD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5905
Mailing Address - Country:US
Mailing Address - Phone:432-687-1949
Mailing Address - Fax:432-688-0823
Practice Address - Street 1:5813 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5055
Practice Address - Country:US
Practice Address - Phone:432-570-0052
Practice Address - Fax:432-570-0053
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652699363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01843051OtherRAILROAD
TX211853101Medicaid