Provider Demographics
NPI:1598447666
Name:MILLIGAN, MARYSSA LYNNE
Entity Type:Individual
Prefix:
First Name:MARYSSA
Middle Name:LYNNE
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13735 PLAYA LUCIA CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-1220
Mailing Address - Country:US
Mailing Address - Phone:281-221-4303
Mailing Address - Fax:
Practice Address - Street 1:451 KINGWOOD MEDICAL DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6407
Practice Address - Country:US
Practice Address - Phone:281-359-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808831163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery