Provider Demographics
NPI:1851155881
Name:YANEZ, MARISSA DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:DANIELLE
Last Name:YANEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:DANIELLE
Other - Last Name:AUGSPURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 N TEXAS AVE STE 3100
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4970
Mailing Address - Country:US
Mailing Address - Phone:281-338-7135
Mailing Address - Fax:
Practice Address - Street 1:333 N TEXAS AVE STE 3100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4970
Practice Address - Country:US
Practice Address - Phone:281-338-7135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17785363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical