Provider Demographics
NPI:1659838159
Name:DORSEY, MARISSA BRIANNE
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:BRIANNE
Last Name:DORSEY
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 1:4100 W 24TH PL APT E24
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2028
Mailing Address - Country:US
Mailing Address - Phone:608-397-3428
Mailing Address - Fax:
Practice Address - Street 1:4100 W 24TH PL APT E24
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2028
Practice Address - Country:US
Practice Address - Phone:608-397-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program