Healthcare Provider Details

I. General information

NPI: 1588447841
Provider Name (Legal Business Name): MARISSA ANNE SCHUETTE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAIRPIN DR
EDWARDSVILLE IL
62026-0001
US

IV. Provider business mailing address

1 HAIRPIN DR
EDWARDSVILLE IL
62026-0001
US

V. Phone/Fax

Practice location:
  • Phone: 618-650-3956
  • Fax:
Mailing address:
  • Phone: 618-650-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018021437
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number2018021437
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: