Healthcare Provider Details

I. General information

NPI: 1063376382
Provider Name (Legal Business Name): MARISSA HAMMONTREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 US-6 W
IOWA CITY IA
52246
US

IV. Provider business mailing address

601 US-6 W
IOWA CITY IA
52246
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number302295
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: