MEDICARE: MARISSA MARSH CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP027129	PA

General Provider Information

NPI Number	:	1356036842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA MARSH CRNP

Provider Business Mailing Address
First Line	:	2100 MACK BLVD FL 2
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-5622
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 N 1ST ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1450
Country	:	US
Telephone Number	:	484-464-9510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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