Provider Demographics
NPI:1790127470
Name:SHUKAREY, MARISSA LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:SHUKAREY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LYNN
Other - Last Name:MYHRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3472 HIDDEN HILLS LN NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-6201
Mailing Address - Country:US
Mailing Address - Phone:507-358-8537
Mailing Address - Fax:
Practice Address - Street 1:3472 HIDDEN HILLS LN NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-6201
Practice Address - Country:US
Practice Address - Phone:507-358-8537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-1657287367500000X
MN0152367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered