Provider Demographics
NPI:1245200260
Name:GLASSANOS, MARIANNE RUSKAY (PNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:RUSKAY
Last Name:GLASSANOS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POPES LN
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-2902
Mailing Address - Country:US
Mailing Address - Phone:781-740-1403
Mailing Address - Fax:
Practice Address - Street 1:179 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2959
Practice Address - Country:US
Practice Address - Phone:508-427-7700
Practice Address - Fax:508-427-7755
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127115363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics