Healthcare Provider Details

I. General information

NPI: 1578403226
Provider Name (Legal Business Name): MARISSA KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

54455 AVENIDA MADERO
LA QUINTA CA
92253-3620
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95253923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: