Provider Demographics
NPI:1285181925
Name:ECHEVERRIA, ANALISA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:ANALISA
Middle Name:
Last Name:ECHEVERRIA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ANALISA
Other - Middle Name:
Other - Last Name:POTISHNAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 MUSEUM WAY APT 1726
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1898
Mailing Address - Country:US
Mailing Address - Phone:413-374-1864
Mailing Address - Fax:
Practice Address - Street 1:391 BROADWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3470
Practice Address - Country:US
Practice Address - Phone:617-389-2121
Practice Address - Fax:617-389-4194
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2299550363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics