Basic Information
| Provider Information | |||||||||
| NPI: | 1508300575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPKINS | ||||||||
| FirstName: | MARISSA | ||||||||
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| Credential: | FNP, MSN, RN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8234 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923751434 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | LOMA LINDA VA MEDICAL CTR | ||||||||
| Address2: | 11201 BENTON ST | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2016 | ||||||||
| LastUpdateDate: | 12/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95005510 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.