Provider Demographics
NPI:1356434567
Name:GROSSI, LISA MARIE (RN, MS, CPNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:GROSSI
Suffix:
Gender:F
Credentials:RN, MS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:SUITE 31
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-522-3100
Mailing Address - Fax:617-522-6366
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 31
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-522-3100
Practice Address - Fax:617-522-6366
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164053-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics