Healthcare Provider Details

I. General information

NPI: 1518620475
Provider Name (Legal Business Name): MARISSA ANNE HULME PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA ANNE MEYER

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 DELHI ST STE 100
DUBUQUE IA
52001-6320
US

IV. Provider business mailing address

1515 DELHI ST STE 100
DUBUQUE IA
52001-6320
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-9111
  • Fax:
Mailing address:
  • Phone: 563-557-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number118095
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: