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General NPI Number Information
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NPI Number | 1437768728
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Entity Type | Individual
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Provider Name | MARISA J NEZARIA NP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 88 MONTVALE AVE STE 3
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City | STONEHAM
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State | MA
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Zip | 02180-3644
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Country | US
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Telephone | 781-481-9255
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Fax | 781-481-9257
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Provider Business Mailing Address
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Address Line | 88 MONTVALE AVE STE 3
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City | STONEHAM
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State | MA
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Zip | 02180-3644
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Country | US
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Telephone | 781-481-9255
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Fax | 781-481-9257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2328815
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2328815
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2328815
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License Number State | MA
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