Provider Demographics
NPI:1033534334
Name:PATRICK, MARISSA JANE (APRN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JANE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:JANE
Other - Last Name:HURLBURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CMVC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-479-2546
Mailing Address - Fax:802-479-1346
Practice Address - Street 1:14 N MAIN ST
Practice Address - Street 2:STE 4002
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4197
Practice Address - Country:US
Practice Address - Phone:802-479-2546
Practice Address - Fax:802-479-1346
Is Sole Proprietor?:No
Enumeration Date:2014-02-23
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0116285363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology