Individual
MARISSA NICOLE MAEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
205 S 6TH ST, MALTA, IL 60150-9703
(815) 761-8707
Mailing address
205 S 6TH ST, PO BOX 99, MALTA, IL 60150-9703
(815) 761-8707
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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