Individual
MARISSA ROSE LEAVERSUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
280 BEACH STREET, REVERE, MA 02151
(781) 289-5057
(781) 289-4485
Mailing address
280 BEACH STREET, REVERE, MA 02151
(781) 289-5057
(781) 289-4485
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN260274
MA
Other
Enumeration date
09/10/2008
Last updated
07/03/2019
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