Provider Demographics
NPI:1437553823
Name:RIVARD, MARIANNE ELISABETH (NP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:ELISABETH
Last Name:RIVARD
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 1:60 MESSENGER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2258
Mailing Address - Country:US
Mailing Address - Phone:508-316-7438
Mailing Address - Fax:508-342-1912
Practice Address - Street 1:60 MESSENGER ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2258
Practice Address - Country:US
Practice Address - Phone:508-316-7438
Practice Address - Fax:508-342-1912
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2275355363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110102264AMedicaid