Healthcare Provider Details

I. General information

NPI: 1497637102
Provider Name (Legal Business Name): MARISSA LA HAIR DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BAKER AVE
CONCORD MA
01742-2129
US

IV. Provider business mailing address

330 BAKER AVE
CONCORD MA
01742-2129
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-9300
  • Fax:
Mailing address:
  • Phone: 978-287-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2354513
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2354513
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: