Individual
MARISSA LEE COPPERSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-8000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
245979-30
WI
363L00000X
Nurse Practitioner
Primary
18500
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100423004
—
WI
Enumeration date
04/28/2026
Last updated
08/04/2026
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