Provider Demographics
NPI:1255487211
Name:THERRIEN, VIVIAN IRENE
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:IRENE
Last Name:THERRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MERCHANT LN
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:ME
Mailing Address - Zip Code:04606-3363
Mailing Address - Country:US
Mailing Address - Phone:207-497-5633
Mailing Address - Fax:207-497-5633
Practice Address - Street 1:20 MERCHANT LN
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:ME
Practice Address - Zip Code:04606-3363
Practice Address - Country:US
Practice Address - Phone:207-497-5633
Practice Address - Fax:207-497-5633
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME198850000Medicaid