Provider Demographics
NPI:1033751490
Name:CASEY, MARISSA (DNP, ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 E AVE
Mailing Address - Street 2:
Mailing Address - City:LADORA
Mailing Address - State:IA
Mailing Address - Zip Code:52251-7508
Mailing Address - Country:US
Mailing Address - Phone:319-930-1071
Mailing Address - Fax:
Practice Address - Street 1:1481 E AVE
Practice Address - Street 2:
Practice Address - City:LADORA
Practice Address - State:IA
Practice Address - Zip Code:52251-7508
Practice Address - Country:US
Practice Address - Phone:319-930-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA156278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily