Provider Demographics
NPI:1861199572
Name:LASSER, NINA CAROLINE (FNP-C)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:CAROLINE
Last Name:LASSER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5221
Mailing Address - Country:US
Mailing Address - Phone:617-797-1512
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST STE 420
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2197
Practice Address - Country:US
Practice Address - Phone:781-235-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2321576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily