Provider Demographics
NPI:1992211478
Name:MARQUEZ, MARISSA MANIPUD (DNP, FNP, RN)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:MANIPUD
Last Name:MARQUEZ
Suffix:
Gender:
Credentials:DNP, FNP, RN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ABAD
Other - Last Name:MANIPUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:27TH SPECIAL OPERATIONS MEDICAL GROUP
Mailing Address - Street 2:224 W.D. L INGRAM AVENUE, BLDG 1408
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103
Mailing Address - Country:US
Mailing Address - Phone:575-784-4037
Mailing Address - Fax:
Practice Address - Street 1:224 W.D. L INGRAM AVENUE, BLDG 1408
Practice Address - Street 2:
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-784-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008125363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily