Provider Demographics
NPI:1093332082
Name:CHASE, MARISSA KATHERINE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KATHERINE
Last Name:CHASE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 W DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-5808
Mailing Address - Country:US
Mailing Address - Phone:410-409-1332
Mailing Address - Fax:
Practice Address - Street 1:340 E PALM LN # A175
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4603
Practice Address - Country:US
Practice Address - Phone:602-386-1100
Practice Address - Fax:602-386-1150
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ232023363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care