Most Relevant Information
Provider Data
| NPI Number: | 1003650920 |
| Provider Name: | MARISSA ROSE VANDER MISSEN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/24/2024 |
| Last Updated: | 06/24/2024 |
Provider Practice Location
340 W 10TH ST
INDIANAPOLIS
IN
462023082
Practice Location Phone/Fax
| Phone: | 3172748157 |
| Fax: |
Provider Mailing Location
824 N CALIFORNIA ST
INDIANAPOLIS
IN
462023046
Provider Mailing Phone/Fax
| Phone: | 3177539375 |
| Fax: |