Provider Demographics
NPI:1386396398
Name:HUETTMAN, MARISSA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:HUETTMAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 WOODLAND CT
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2142
Mailing Address - Country:US
Mailing Address - Phone:563-940-3385
Mailing Address - Fax:
Practice Address - Street 1:865 LINCOLN RD STE 100
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4159
Practice Address - Country:US
Practice Address - Phone:563-355-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF166983363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
104416834OtherNATIONAL CERTIFICATION CORPORATION