Provider Demographics
NPI:1689298879
Name:SIMPSON, MARISSA JENEE (CNP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JENEE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7287
Mailing Address - Country:US
Mailing Address - Phone:755-538-2981
Mailing Address - Fax:855-653-5171
Practice Address - Street 1:1600 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7287
Practice Address - Country:US
Practice Address - Phone:755-538-2981
Practice Address - Fax:855-653-5171
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily