Provider Demographics
NPI:1033881636
Name:SEVENISH, MARISSA RENEE (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:RENEE
Last Name:SEVENISH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:1513 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1434
Practice Address - Country:US
Practice Address - Phone:734-475-9175
Practice Address - Fax:734-475-0120
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI202018948363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics