Provider Demographics
NPI:1548737661
Name:GARRETT, MARISSA JUNE (DNP, AGNP)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:JUNE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:DNP, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 185TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-6006
Mailing Address - Country:US
Mailing Address - Phone:253-414-5433
Mailing Address - Fax:
Practice Address - Street 1:1811 HOWARD RD STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-6311
Practice Address - Country:US
Practice Address - Phone:877-522-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60892327363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner