Provider Demographics
NPI:1790050169
Name:HERRICK, MARIE LOUISE (CNM)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:HERRICK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:LOUISE
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:888-607-0046
Mailing Address - Fax:
Practice Address - Street 1:12 CASE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:888-607-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-18
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153091367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife