Provider Demographics
NPI:1770223240
Name:KRESS, MARISA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:LYNN
Last Name:KRESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:MARISA
Other - Middle Name:LYNN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 NW BARSTOW ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-548-6903
Mailing Address - Fax:
Practice Address - Street 1:210 NW BARSTOW ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3771
Practice Address - Country:US
Practice Address - Phone:262-548-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program