Provider Demographics
NPI:1548653058
Name:CRUZ, MARISSA G (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:G
Last Name:CRUZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MS, CNS
Mailing Address - Street 1:10300 NE HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3831
Mailing Address - Country:US
Mailing Address - Phone:503-257-5500
Mailing Address - Fax:
Practice Address - Street 1:1950 NW MYHRE RD FL 3
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7662
Practice Address - Country:US
Practice Address - Phone:564-240-4200
Practice Address - Fax:564-240-4299
Is Sole Proprietor?:No
Enumeration Date:2015-03-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61216498363LA2100X, 363LA2100X
OR10030517363LA2100X
WA60497895163W00000X
CA95029705363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10030517OtherOREGON STATE BOARD OF NURSING
WAAP61216498OtherWASHINGTON STATE BOARD OF NURSING