Provider Demographics
NPI:1891070157
Name:MARSICOVETERE, PRISCILLA S (PA-C)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:S
Last Name:MARSICOVETERE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SCHOOLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-4429
Mailing Address - Country:US
Mailing Address - Phone:802-478-4080
Mailing Address - Fax:
Practice Address - Street 1:456 UNION ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5215
Practice Address - Country:US
Practice Address - Phone:866-679-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant