Healthcare Provider Details

I. General information

NPI: 1336743988
Provider Name (Legal Business Name): MARI CHRISTINE DEGRASSE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N MAIN ST
RANDOLPH MA
02368-3663
US

IV. Provider business mailing address

260 WILLOW AVE
HAVERHILL MA
01835-8353
US

V. Phone/Fax

Practice location:
  • Phone: 761-961-0800
  • Fax:
Mailing address:
  • Phone: 978-204-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10201517
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2318915
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: