Healthcare Provider Details

I. General information

NPI: 1437768728
Provider Name (Legal Business Name): MARISA J NEZARIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISA ALBERT

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MONTVALE AVE STE 3
STONEHAM MA
02180-3644
US

IV. Provider business mailing address

88 MONTVALE AVE STE 3
STONEHAM MA
02180-3644
US

V. Phone/Fax

Practice location:
  • Phone: 781-481-9255
  • Fax: 781-481-9257
Mailing address:
  • Phone: 781-481-9255
  • Fax: 781-481-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2328815
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2328815
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2328815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: