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NPI Code Detail

MEDICARE: MARISSA WU

MEDICARE: MARISSA WU
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1720920127
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA WU
Provider Business Mailing Address
First Line : 300 PARKVIEW PL
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4550
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 PARKVIEW PL
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4550
Country : US
Telephone Number : 867-683-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ MARISSA WU ” Practice Location

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