Provider Demographics
NPI:1760999692
Name:SHISLER, MARISSA ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELIZABETH
Last Name:SHISLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ELIZABETH
Other - Last Name:CASSIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4020 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001
Mailing Address - Country:US
Mailing Address - Phone:719-546-3600
Mailing Address - Fax:719-546-0931
Practice Address - Street 1:4020 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-546-3600
Practice Address - Fax:719-546-0931
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-30
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993611-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14612324OtherCAQH
CO9000163803Medicaid