Provider Demographics
NPI:1689208456
Name:BLANCHARD, MARISSA LYN
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYN
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 VILLAGE CIRCLE WAY APT 18
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-7114
Mailing Address - Country:US
Mailing Address - Phone:603-773-8895
Mailing Address - Fax:
Practice Address - Street 1:165 VILLAGE CIRCLE WAY APT 18
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-7114
Practice Address - Country:US
Practice Address - Phone:603-773-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide