Healthcare Provider Details

I. General information

NPI: 1033751490
Provider Name (Legal Business Name): MARISSA CASEY DNP, ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 01/19/2020
Certification Date: 01/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 E AVE
LADORA IA
52251-7508
US

IV. Provider business mailing address

1481 E AVE
LADORA IA
52251-7508
US

V. Phone/Fax

Practice location:
  • Phone: 319-930-1071
  • Fax:
Mailing address:
  • Phone: 319-930-1071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA156278
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: