Doctor Name: | MARISSA LAHAIE |
NPI Number: | 1114208758 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 4781 |
Business Practice Address: | 30 Cranberry Bog Rd Danielson, CT - 062393310 |
Business Phone Number: | 8609178516 |
Business Fax Number: | |
Mailing Address: | 30 Cranberry Bog Rd, DANIELSON |
State: | CT |
Postal Code: | 062393310 |
Phone Number: | 8609178516 |
Fax Number: | |
NPI Enumeration Date: | 09/08/2011 |
NPI Last Update Date: | 04/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 4781 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |