Provider Demographics
NPI:1669013744
Name:CADENA, MARISSA LISETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LISETTE
Last Name:CADENA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16305 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6068
Mailing Address - Country:US
Mailing Address - Phone:406-493-6891
Mailing Address - Fax:
Practice Address - Street 1:16305 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6068
Practice Address - Country:US
Practice Address - Phone:406-493-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1864363A00000X
MTMED-PAC-LIC-77760363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical