Healthcare Provider Details

I. General information

NPI: 1033701453
Provider Name (Legal Business Name): MARISSA SHULRUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SACHEM PL
CHARLOTTESVILLE VA
22901-2554
US

IV. Provider business mailing address

000 HAPPY HOSUE
NASHVILLE TN
37240-1104
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number279453
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024194855
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: