Basic Information
| Provider Information | |||||||||
| NPI: | 1700559309 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RECKER | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 BELLEFONTAINE AVE | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458042899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199984575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 W REDSKIN TRL | ||||||||
| Address2: | |||||||||
| City: | WAPAKONETA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458959349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197385151 | ||||||||
| FaxNumber: | 4199411092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2021 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN.CNP.0029141 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.