Provider Demographics
NPI:1619701943
Name:DEMARCO, LEANNA MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:MICHELLE
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 COLGATE RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5602
Mailing Address - Country:US
Mailing Address - Phone:978-317-5483
Mailing Address - Fax:
Practice Address - Street 1:38 COLGATE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5602
Practice Address - Country:US
Practice Address - Phone:978-317-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2302984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner