Provider Demographics
NPI:1891669511
Name:POPPE, MARISSA SUE (RN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:SUE
Last Name:POPPE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TRIMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56176-1275
Mailing Address - Country:US
Mailing Address - Phone:507-848-0662
Mailing Address - Fax:
Practice Address - Street 1:741 190TH ST
Practice Address - Street 2:
Practice Address - City:TRIMONT
Practice Address - State:MN
Practice Address - Zip Code:56176-1275
Practice Address - Country:US
Practice Address - Phone:507-848-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty