Provider Demographics
NPI:1851468581
Name:NEWCOMB, MARILYNN (ANP - BC)
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:ANP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1634
Mailing Address - Country:US
Mailing Address - Phone:781-447-6887
Mailing Address - Fax:
Practice Address - Street 1:HEALTH SERVICES BRIDGEWATER STATE COLLEGE
Practice Address - Street 2:45 SCHOOL ST
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02325-0001
Practice Address - Country:US
Practice Address - Phone:508-531-1252
Practice Address - Fax:508-531-6193
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA96777363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4880Medicare UPIN