Provider Demographics
NPI:1740812601
Name:HUPP, MARISSA (FNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HUPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CORAOPOLIS HEIGHTS RD STE G1
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4307
Mailing Address - Country:US
Mailing Address - Phone:412-329-2642
Mailing Address - Fax:412-269-4116
Practice Address - Street 1:1600 CORAOPOLIS HEIGHTS RD STE G1
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4307
Practice Address - Country:US
Practice Address - Phone:412-329-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily