Provider Demographics
NPI:1922970029
Name:WILLIAMS, MARISSA LYNN (AGNP-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2706
Mailing Address - Country:US
Mailing Address - Phone:978-935-3041
Mailing Address - Fax:
Practice Address - Street 1:12 MILES AVE
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2706
Practice Address - Country:US
Practice Address - Phone:978-935-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2349744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner