Healthcare Provider Details

I. General information

NPI: 1306658570
Provider Name (Legal Business Name): MARISSA AWWAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BJC SAINT PETERS DR STE 200C
SAINT PETERS MO
63376-3385
US

IV. Provider business mailing address

201 BJC SAINT PETERS DR STE 200C
SAINT PETERS MO
63376-3385
US

V. Phone/Fax

Practice location:
  • Phone: 961-563-6916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025003389
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number2018025751
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025003389
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: