Provider Demographics
NPI:1588464275
Name:SHEEHY, MARRISSA L (LPN)
Entity type:Individual
Prefix:
First Name:MARRISSA
Middle Name:L
Last Name:SHEEHY
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2454 NORMANDY DR SE APT 201A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-7921
Mailing Address - Country:US
Mailing Address - Phone:313-671-0174
Mailing Address - Fax:
Practice Address - Street 1:3101 PRAIRIE ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2047
Practice Address - Country:US
Practice Address - Phone:616-531-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703126097164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse