Provider Demographics
NPI:1497152896
Name:ALBAT, MARISSA ASPEN
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ASPEN
Last Name:ALBAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 E GARFIELD ST STE C
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4893
Mailing Address - Country:US
Mailing Address - Phone:307-742-6572
Mailing Address - Fax:307-742-6572
Practice Address - Street 1:2523 E GARFIELD ST STE C
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4893
Practice Address - Country:US
Practice Address - Phone:307-742-6572
Practice Address - Fax:307-742-6572
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator