Provider Demographics
NPI:1518215490
Name:PITTS, MARIELLE (NP)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIELLE
Other - Middle Name:
Other - Last Name:ZYLSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2038
Mailing Address - Country:US
Mailing Address - Phone:508-852-0600
Mailing Address - Fax:
Practice Address - Street 1:176 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2236
Practice Address - Country:US
Practice Address - Phone:508-634-5026
Practice Address - Fax:508-634-5055
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00771363LA2200X
MARN265510363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health