Provider Demographics
NPI:1528375706
Name:MCCUNE, MARISA L (APN)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:L
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MARISA
Other - Middle Name:L
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:4321 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1269
Mailing Address - Country:US
Mailing Address - Phone:563-421-5315
Mailing Address - Fax:
Practice Address - Street 1:4321 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1269
Practice Address - Country:US
Practice Address - Phone:563-421-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-008304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner