Individual
MARCIE J PASANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
010958-1
NY
363A00000X
Physician Assistant
Primary
PA00514
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013003
RI MEDICARE
RI
05
—
02710965
—
NY
01
—
09/30/2009
BCBS
RI
01
—
11/12/2009
NHPRI
RI
05
—
MP77461
—
RI
Enumeration date
06/23/2006
Last updated
02/16/2010
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