Basic Information
| Provider Information | |||||||||
| NPI: | 1831423656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAMSEY | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2095 FLORENCE BLVD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356302751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563495275 | ||||||||
| FaxNumber: | 2563495279 | ||||||||
| Practice Location | |||||||||
| Address1: | 2095 FLORENCE BLVD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356302751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563495275 | ||||||||
| FaxNumber: | 2563495279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2009 | ||||||||
| LastUpdateDate: | 08/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-097505 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 511-69336 | 01 | AL | BCBS AL | OTHER | 184610 | 05 | AL | MEDICAID |