Provider Demographics
NPI:1669014189
Name:FEENEY, MARISSA LAURETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:LAURETTE
Last Name:FEENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 E 1700 AVE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-4028
Mailing Address - Country:US
Mailing Address - Phone:618-704-5945
Mailing Address - Fax:888-618-8106
Practice Address - Street 1:692 E 1700 AVE
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-4028
Practice Address - Country:US
Practice Address - Phone:618-704-5945
Practice Address - Fax:888-618-8106
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.141060207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology