Provider Demographics
NPI:1841924016
Name:RICHARDSON, MARISSA ERIN (APN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ERIN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ERIN
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 BINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4762
Mailing Address - Country:US
Mailing Address - Phone:732-775-9075
Mailing Address - Fax:
Practice Address - Street 1:301 BINGHAM AVE
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4762
Practice Address - Country:US
Practice Address - Phone:732-775-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01338000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner