Healthcare Provider Details

I. General information

NPI: 1497137277
Provider Name (Legal Business Name): MARISSA MARTIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA HILL PMHNP

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 N MAIN ST
RUTLAND VT
05701-2412
US

IV. Provider business mailing address

662 REMINGTON RD
CHESTER VT
05143-8519
US

V. Phone/Fax

Practice location:
  • Phone: 802-772-7992
  • Fax:
Mailing address:
  • Phone: 802-631-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number071823-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberEL32841
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0134355
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: