Healthcare Provider Details

I. General information

NPI: 1588464275
Provider Name (Legal Business Name): MARRISSA L SHEEHY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 PRAIRIE ST SW
GRANDVILLE MI
49418-2047
US

IV. Provider business mailing address

2454 NORMANDY DR SE APT 201A
GRAND RAPIDS MI
49506-7921
US

V. Phone/Fax

Practice location:
  • Phone: 616-531-9973
  • Fax:
Mailing address:
  • Phone: 313-671-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703126097
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: