Provider Demographics
NPI:1568739480
Name:WATRISS, ARIEL LEORA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:LEORA
Last Name:WATRISS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:PERSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 PROFESSORS ROW
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:617-627-3350
Mailing Address - Fax:
Practice Address - Street 1:1340 BOYLSTON ST FL 8
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4302
Practice Address - Country:US
Practice Address - Phone:617-927-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264455363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health