Provider Demographics
NPI:1083412662
Name:NOOT, MARISSA DANYELLE (PA)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:DANYELLE
Last Name:NOOT
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 S CLOVER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KEARNS
Mailing Address - State:UT
Mailing Address - Zip Code:84118-9210
Mailing Address - Country:US
Mailing Address - Phone:385-290-2758
Mailing Address - Fax:
Practice Address - Street 1:6224 S CLOVER CREEK LN
Practice Address - Street 2:
Practice Address - City:KEARNS
Practice Address - State:UT
Practice Address - Zip Code:84118-9210
Practice Address - Country:US
Practice Address - Phone:385-290-2758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant