Provider Demographics
NPI:1255941274
Name:NUNEZ, MARISSA ELIZABETH
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ELIZABETH
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 BROKEN TWIG CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0704
Mailing Address - Country:US
Mailing Address - Phone:702-301-9253
Mailing Address - Fax:
Practice Address - Street 1:2105 BROKEN TWIG CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0704
Practice Address - Country:US
Practice Address - Phone:702-301-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant