Provider Demographics
NPI:1982756250
Name:CAVALIER, MARISSA COLLEEN (ND)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:COLLEEN
Last Name:CAVALIER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 FORT MISSOULA RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7479
Mailing Address - Country:US
Mailing Address - Phone:480-628-3002
Mailing Address - Fax:406-363-5645
Practice Address - Street 1:2831 FORT MISSOULA RD STE 203
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7479
Practice Address - Country:US
Practice Address - Phone:480-628-3002
Practice Address - Fax:406-363-5645
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT98175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath