Provider Demographics
NPI:1881224848
Name:LIBBY, NARISSA MAE
Entity Type:Individual
Prefix:
First Name:NARISSA
Middle Name:MAE
Last Name:LIBBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2628
Mailing Address - Country:US
Mailing Address - Phone:207-671-5727
Mailing Address - Fax:
Practice Address - Street 1:9 QUEEN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-2628
Practice Address - Country:US
Practice Address - Phone:207-671-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program