Provider Demographics
NPI:1942617253
Name:MASCIARELLI, LISA ANNE (RN,MSN,CPNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:MASCIARELLI
Suffix:
Gender:F
Credentials:RN,MSN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-885-2003
Mailing Address - Fax:508-885-8071
Practice Address - Street 1:64 BOYDEN RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520
Practice Address - Country:US
Practice Address - Phone:508-885-2003
Practice Address - Fax:508-885-8071
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269877363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110100499AMedicaid