Provider Demographics
NPI:1952117350
Name:ALDEEN, MARISSA ANN (LPN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:ALDEEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ANN
Other - Last Name:STAIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2101 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2417
Mailing Address - Country:US
Mailing Address - Phone:701-461-7343
Mailing Address - Fax:701-239-2406
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-461-7343
Practice Address - Fax:701-239-2406
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL11204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse