Provider Demographics
NPI:1962994483
Name:RUEBHAUSEN, MARISSA NICOLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:NICOLE
Last Name:RUEBHAUSEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:NICOLE
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:375 N WALL ST STE P520
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3493
Mailing Address - Country:US
Mailing Address - Phone:815-932-6632
Mailing Address - Fax:815-932-5760
Practice Address - Street 1:375 N WALL ST STE P520
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3493
Practice Address - Country:US
Practice Address - Phone:815-932-6632
Practice Address - Fax:815-932-5760
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily