Provider Demographics
NPI:1972251817
Name:CASILLO, MARISSA JANE (FNP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JANE
Last Name:CASILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BOSTON ST STE 6
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1223
Mailing Address - Country:US
Mailing Address - Phone:978-887-1146
Mailing Address - Fax:
Practice Address - Street 1:9 PAYSON RD
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1309
Practice Address - Country:US
Practice Address - Phone:781-551-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF03210086363LF0000X
MARN2273512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily