Provider Demographics
NPI:1174920375
Name:OXEREOK, MARISSA KAYE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:KAYE
Last Name:OXEREOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SNOWBANK RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:AK
Mailing Address - Zip Code:99783
Mailing Address - Country:US
Mailing Address - Phone:907-664-3311
Mailing Address - Fax:907-664-3471
Practice Address - Street 1:530 SNOWBANK RD
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:AK
Practice Address - Zip Code:99783
Practice Address - Country:US
Practice Address - Phone:907-664-3311
Practice Address - Fax:907-664-3471
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCHA IIIOtherCHA III