Healthcare Provider Details

I. General information

NPI: 1710825971
Provider Name (Legal Business Name): MARISSA HENRIETTA VANARSDALE CNA, RMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 BUSH LN
HARDY VA
24101-6212
US

IV. Provider business mailing address

469 BUSH LN
HARDY VA
24101-6212
US

V. Phone/Fax

Practice location:
  • Phone: 540-682-0662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number0031014596
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: