Provider Demographics
NPI:1790329233
Name:HUPPER, MARIE A (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:HUPPER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2045
Mailing Address - Country:US
Mailing Address - Phone:207-535-8210
Mailing Address - Fax:
Practice Address - Street 1:35 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2045
Practice Address - Country:US
Practice Address - Phone:207-369-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily