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General NPI Number Information
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NPI Number | 1497137277
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Entity Type | Individual
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Provider Name | MARISSA MARTIN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 231 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-2412
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Country | US
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Telephone | 802-772-7992
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Fax |
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Provider Business Mailing Address
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Address Line | 662 REMINGTON RD
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City | CHESTER
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State | VT
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Zip | 05143-8519
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Country | US
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Telephone | 802-631-0099
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Fax |
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 071823-21
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | EL32841
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0134355
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License Number State | VT
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