Provider Demographics
NPI:1033683404
Name:CHESEBRO, MARISSA (CST)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CHESEBRO
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9499 W CHARLESTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7147
Mailing Address - Country:US
Mailing Address - Phone:702-933-9393
Mailing Address - Fax:
Practice Address - Street 1:9260 W SUNSET RD STE 309
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4858
Practice Address - Country:US
Practice Address - Phone:702-963-1231
Practice Address - Fax:702-442-9309
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist