Provider Demographics
NPI:1659508414
Name:WIERZBINSKI, MARIANNE (RN/NP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:WIERZBINSKI
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-0483
Mailing Address - Country:US
Mailing Address - Phone:508-255-6297
Mailing Address - Fax:774-316-4180
Practice Address - Street 1:107 ROCK HARBOR RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-2309
Practice Address - Country:US
Practice Address - Phone:508-255-6297
Practice Address - Fax:774-316-4180
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN186467363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110037835AMedicaid