Individual
MARISSA PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
759 CHESTNUT ST, SPRINGFIELD, MA 01199-1001
(413) 795-0754
Mailing address
14 BAILEY RD, ENFIELD, CT 06082-4805
(413) 654-6153
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2301689
MA
Other
Enumeration date
07/18/2024
Last updated
07/18/2024
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