Provider Demographics
NPI:1790875169
Name:DENINE, MARCIA L (NP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:DENINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-1619
Mailing Address - Country:US
Mailing Address - Phone:508-627-5797
Mailing Address - Fax:508-627-5799
Practice Address - Street 1:245 EDGARTOWN VINEYARD HAVEN RD
Practice Address - Street 2:
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-6941
Practice Address - Country:US
Practice Address - Phone:508-627-5797
Practice Address - Fax:508-627-5799
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA250377363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0711101Medicaid