Provider Demographics
NPI:1033404090
Name:CROTEAU, MARIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:SOUCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 BROADWAY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2754
Mailing Address - Country:US
Mailing Address - Phone:978-458-0475
Mailing Address - Fax:978-458-3574
Practice Address - Street 1:155 BROADWAY RD STE 6
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2754
Practice Address - Country:US
Practice Address - Phone:978-458-0475
Practice Address - Fax:978-458-3574
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant