Provider Demographics
NPI:1245851948
Name:IDDINGS, MARISSA (LPN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:IDDINGS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:TRUNZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:71 SHERRILL ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1156
Mailing Address - Country:US
Mailing Address - Phone:315-651-7527
Mailing Address - Fax:
Practice Address - Street 1:71 SHERRILL ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1156
Practice Address - Country:US
Practice Address - Phone:315-651-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327282164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse