Provider Demographics
NPI:1437793510
Name:MCINTYRE, MARISSA M (CRNP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:M
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3401 INDEPENDENCE DRIVE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-930-0080
Mailing Address - Fax:205-802-2240
Practice Address - Street 1:3401 INDEPENDENCE DRIVE
Practice Address - Street 2:SUITE 221
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-930-0080
Practice Address - Fax:205-802-2240
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-143798163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse