Provider Demographics
NPI:1831954437
Name:ESPY, MARISSA LORNA (RN)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:LORNA
Last Name:ESPY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:PONCHA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81242-0524
Mailing Address - Country:US
Mailing Address - Phone:775-790-5716
Mailing Address - Fax:
Practice Address - Street 1:1113 AGATE LN
Practice Address - Street 2:
Practice Address - City:PONCHA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81242
Practice Address - Country:US
Practice Address - Phone:775-790-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1669417163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice