Healthcare Provider Details

I. General information

NPI: 1609211416
Provider Name (Legal Business Name): MARISSA DESIREE PEREZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 E BADDOUR PKWY
LEBANON TN
37087-3706
US

IV. Provider business mailing address

2789 JENOAKS PASS
HERMITAGE TN
37076-3744
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-5325
  • Fax:
Mailing address:
  • Phone: 615-600-9508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000179513
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: