Provider Demographics
NPI:1154046738
Name:PERKINS, MARISSA ASHLEY (CRNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ASHLEY
Last Name:PERKINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8894 STANFORD BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5161
Mailing Address - Country:US
Mailing Address - Phone:410-997-7226
Mailing Address - Fax:410-997-7226
Practice Address - Street 1:8894 STANFORD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4794
Practice Address - Country:US
Practice Address - Phone:410-997-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR230832363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health