Individual
MARISSA LYNETTE COMMODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5357 WINDFERN CT, STONE MOUNTAIN, GA 30088-3329
(770) 875-3080
Mailing address
5357 WINDFERN CT, STONE MOUNTAIN, GA 30088-3329
(770) 875-3080
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
RN264280
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN264280
GA
Other
Enumeration date
06/28/2021
Last updated
05/23/2024
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