Healthcare Provider Details

I. General information

NPI: 1205481868
Provider Name (Legal Business Name): MARISSA MICHELLE YEPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 AVENUE E
BILLINGS MT
59102-6561
US

IV. Provider business mailing address

3401 AVENUE E
BILLINGS MT
59102-6561
US

V. Phone/Fax

Practice location:
  • Phone: 406-281-8700
  • Fax:
Mailing address:
  • Phone: 406-281-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP142499
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: