Healthcare Provider Details

I. General information

NPI: 1053243055
Provider Name (Legal Business Name): MARISSA HENDRICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W GRAND RIVER AVE STE 300
HOWELL MI
48843-3970
US

IV. Provider business mailing address

1225 W GRAND RIVER AVE STE 300
HOWELL MI
48843-3970
US

V. Phone/Fax

Practice location:
  • Phone: 810-631-3383
  • Fax: 810-631-0507
Mailing address:
  • Phone: 810-631-3383
  • Fax: 810-631-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704346080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: