Provider Demographics
NPI:1720697378
Name:BERNABE, MARISSA L (APRN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:L
Last Name:BERNABE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 SE WASHINGTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:539-529-6230
Mailing Address - Fax:539-529-6239
Practice Address - Street 1:2431 SE WASHINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:539-529-6230
Practice Address - Fax:539-529-6239
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK212058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily