Provider Demographics
NPI:1548318249
Name:PROVIDER PLUS LLC
Entity type:Organization
Organization Name:PROVIDER PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:GNP
Authorized Official - Phone:832-878-1377
Mailing Address - Street 1:3723 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4787
Mailing Address - Country:US
Mailing Address - Phone:832-264-2133
Mailing Address - Fax:281-485-9817
Practice Address - Street 1:3723 WILLOW SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-4787
Practice Address - Country:US
Practice Address - Phone:832-264-2133
Practice Address - Fax:281-485-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513451364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Single Specialty