Provider Demographics
NPI:1104880053
Name:NIBLOCK, MARILYN ELIZABETH (NNP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ELIZABETH
Last Name:NIBLOCK
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 FM 3405
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4344
Mailing Address - Country:US
Mailing Address - Phone:512-930-1628
Mailing Address - Fax:
Practice Address - Street 1:1231 FM 3405
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4344
Practice Address - Country:US
Practice Address - Phone:512-930-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-15
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX506272363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care