Individual
MARISSA MARIE SUDOMOIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(484) 565-1601
Mailing address
255 W LANCASTER AVE, PAOLI, PA 19301-1763
(484) 565-1601
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
SP023134
PA
Other
Enumeration date
11/29/2021
Last updated
11/29/2021
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