Provider Demographics
NPI:1386692986
Name:FORREST, MARISSA P (CNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:P
Last Name:FORREST
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:140 COLEMANS CROSSING BOULEVARD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-0000
Mailing Address - Country:US
Mailing Address - Phone:937-644-1441
Mailing Address - Fax:937-642-7760
Practice Address - Street 1:140 COLEMANS CROSSING BOULEVARD
Practice Address - Street 2:SUITE 210
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-0000
Practice Address - Country:US
Practice Address - Phone:937-644-1441
Practice Address - Fax:937-642-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-03-22
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.00108363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2023714Medicaid
OHNP04555Medicare PIN
OHNP04555Medicare PIN