Provider Demographics
NPI:1497208847
Name:LARUE, MARILYN P (FNPC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:P
Last Name:LARUE
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:P
Other - Last Name:O'MERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:
Practice Address - Street 1:53 SCHOODIC DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7246
Practice Address - Country:US
Practice Address - Phone:207-338-6900
Practice Address - Fax:207-338-4974
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19207363LF0000X
PASP016245363LF0000X
MECNP211176363L00000X
WVAPRN81605NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty