Provider Demographics
NPI:1316700263
Name:HERRERA, MARISSA KRISTINA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:KRISTINA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIEFER
Mailing Address - State:OK
Mailing Address - Zip Code:74041-3025
Mailing Address - Country:US
Mailing Address - Phone:918-845-8373
Mailing Address - Fax:
Practice Address - Street 1:1624 E VIRGIN ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-5526
Practice Address - Country:US
Practice Address - Phone:918-644-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management