Provider Demographics
NPI:1174221832
Name:WESH, MARISA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:WESH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NUTMEG DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-4218
Mailing Address - Country:US
Mailing Address - Phone:856-628-7858
Mailing Address - Fax:
Practice Address - Street 1:401 LACEY RD STE B
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1386
Practice Address - Country:US
Practice Address - Phone:732-849-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01391500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily