Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2019040442 | MO |
N | 363LG0600X | Nurse Practitioner - Gerontology | 2019001529 | MO |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2019040441 | MO |
NPI | 1023610318 |
---|---|
Provider Name | Alyssa Danielle Marso |
First Address | Clinton, MO 64735-8804 |
Second Address | Columbia, MO 65201-6584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2020 |
Last Update Date | 11/11/2020 |