Provider Demographics
NPI:1144666330
Name:POTTER, MARISSA (CD, CCE)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:CD, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SEARS ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-1009
Mailing Address - Country:US
Mailing Address - Phone:413-522-3949
Mailing Address - Fax:
Practice Address - Street 1:32 SEARS ST
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-1009
Practice Address - Country:US
Practice Address - Phone:413-522-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula