Provider Demographics
NPI:1972185734
Name:TOURVILLE, MARISSA L (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:L
Last Name:TOURVILLE
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Gender:F
Credentials:MS, PA-C
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Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-9093
Mailing Address - Fax:
Practice Address - Street 1:82 NEW PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH FRANKLIN
Practice Address - State:CT
Practice Address - Zip Code:06254-1807
Practice Address - Country:US
Practice Address - Phone:860-889-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT23.005446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant