Individual
MARISSA PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
930 COMMONWEALTH AVE, BOSTON, MA 02215-1274
(617) 414-6800
(617) 414-6800
Mailing address
1 ARBROTH ST, BOSTON, MA 02122-2511
(603) 401-2389
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
RN2343674
MA
Other
Enumeration date
03/17/2026
Last updated
03/17/2026
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