Provider Demographics
NPI:1982475141
Name:PINCKARD, MARISSA LYN (RN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYN
Last Name:PINCKARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LYN
Other - Last Name:BATHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:16160 MATCH POINTE CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-9725
Mailing Address - Country:US
Mailing Address - Phone:760-977-8307
Mailing Address - Fax:
Practice Address - Street 1:16160 MATCH POINTE CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-9725
Practice Address - Country:US
Practice Address - Phone:760-977-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95191602163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse