Marissa Beth Hake, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041425862 Issued in IL

Practice address

11020 State Route 250
Lawrenceville, IL 62439-3379

Phone

(618) 943-3754

Fax

(618) 943-3657

NPI assigned

Jun 4, 2018

Last updated

Jun 4, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1679065742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11362 COUNTRY CLUB RD",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624394325",
            "telephone_number": "618-943-3754",
            "fax_number": "618-943-3657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11020 STATE ROUTE 250",
            "city": "LAWRENCEVILLE",
            "state": "IL",
            "postal_code": "624393379",
            "telephone_number": "618-943-3754",
            "fax_number": "618-943-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAKE",
        "first_name": "MARISSA",
        "middle_name": "BETH",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-04",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041425862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Good Samaritan Hospital Physician Services, Inc (Tbil)
• Riley Goupil
• Kila Gray
• Malerie Gray
• Emily Hafenbridle, BS
• Tina Kaye Hake
• Lorenzo N Harford
• Sarah B Harlan
• Miranda L Harrell
• Ryan M Hawkins, PTA

• Registered Nurse in Lawrenceville, IL
• Providers in Lawrenceville, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.