Provider Demographics
NPI:1518025543
Name:HARMON, MARIANNE N (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:N
Last Name:HARMON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:NASSIF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-4624
Mailing Address - Fax:207-662-3258
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-4624
Practice Address - Fax:207-662-3258
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER036907363LA2200X
MEMT3943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP2383Medicare PIN
MENP238301Medicare PIN