Provider Demographics
NPI:1609083617
Name:MAILLOUX, MARLENE SCHIRF (MSRN-CFNP)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:SCHIRF
Last Name:MAILLOUX
Suffix:
Gender:F
Credentials:MSRN-CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1404
Mailing Address - Country:US
Mailing Address - Phone:508-358-4641
Mailing Address - Fax:
Practice Address - Street 1:FRAMINGHAM STATE COLLEGE HEALTH SERVICES
Practice Address - Street 2:100 STATE ST.
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701
Practice Address - Country:US
Practice Address - Phone:508-626-4900
Practice Address - Fax:508-626-4024
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA91533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily