Provider Demographics
NPI:1154848703
Name:FONSECA, MARIANNE K (RN)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:K
Last Name:FONSECA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:ONSET
Mailing Address - State:MA
Mailing Address - Zip Code:02558-1292
Mailing Address - Country:US
Mailing Address - Phone:508-295-5232
Mailing Address - Fax:508-295-5233
Practice Address - Street 1:18 UNION AVE
Practice Address - Street 2:
Practice Address - City:ONSET
Practice Address - State:MA
Practice Address - Zip Code:02558
Practice Address - Country:US
Practice Address - Phone:508-295-5232
Practice Address - Fax:508-295-5233
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1931106S00000X
MARN2310908163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty