Basic Information
| Provider Information | |||||||||
| NPI: | 1689034886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARAZERE | ||||||||
| FirstName: | LINDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 COMMERCE ST | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372011826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154549850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2425 WEST LOOP S STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770274208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327864970 | ||||||||
| FaxNumber: | 8557375542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2016 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0216209 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 366168801 | 05 | TX | MEDICAID |