Provider Demographics
NPI:1073699716
Name:SHAKESPEARE, MARIANNE (NP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:SHAKESPEARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 UNION ST.
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-651-9503
Mailing Address - Fax:508-370-8597
Practice Address - Street 1:67 UNION ST.
Practice Address - Street 2:SUITE 407
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-651-9503
Practice Address - Fax:508-881-1752
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0342700Medicaid
MANP0043Medicare PIN
MAS31546Medicare UPIN