Provider Demographics
NPI:1609443373
Name:RAPOSA, CARISSA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANN
Last Name:RAPOSA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-9508
Mailing Address - Country:US
Mailing Address - Phone:978-790-7639
Mailing Address - Fax:
Practice Address - Street 1:176 CUT OFF RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005-9508
Practice Address - Country:US
Practice Address - Phone:978-790-7639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN88900164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse