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Organization

MOON SPOT WELLNESS CENTER PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MECHELLE PLASSE APRN, PHD (ADVANCED PRACTICE NURSE PRACTITIONE)
(508) 735-9406
Entity
Organization

Contact information

Practice address
36 N BEDFORD ST STE 3, EAST BRIDGEWATER, MA 02333-1186
(508) 735-9406
(774) 568-5605
Mailing address
1442 OLD PLEASANT ST, BRIDGEWATER, MA 02324-2139
(508) 735-9406
(774) 568-5605

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
176838
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
176838
APRN LICENSE
MA
05
1854984
MA
01
PN0618
BLUE CROSS
MA
Enumeration date
05/25/2018
Last updated
05/25/2018
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