Provider Demographics
NPI:1922711191
Name:MORRISINO, ANI ROSE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANI
Middle Name:ROSE
Last Name:MORRISINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:ROSE
Other - Last Name:DERDERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1426 COLUMBIA RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 BOYLSTON ST STE 201
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1978
Practice Address - Country:US
Practice Address - Phone:617-831-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2300984363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health