Provider Demographics
NPI:1871245647
Name:MARQUSEE, MARISSA ELIZABETH HOLLAND (LVN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELIZABETH HOLLAND
Last Name:MARQUSEE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 RODNEY DR APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2631
Mailing Address - Country:US
Mailing Address - Phone:315-262-7161
Mailing Address - Fax:
Practice Address - Street 1:1625 SCHRADER BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6213
Practice Address - Country:US
Practice Address - Phone:323-993-7476
Practice Address - Fax:323-308-4490
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313756164W00000X
CA696428164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse