Provider Demographics
NPI:1134235161
Name:WHIPPLE, MARILYN BROCKWAY (CNS, APRN)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:BROCKWAY
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:CNS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3706
Mailing Address - Country:US
Mailing Address - Phone:207-829-5813
Mailing Address - Fax:
Practice Address - Street 1:34 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-3706
Practice Address - Country:US
Practice Address - Phone:207-829-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER015279163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEWHMM5912Medicare ID - Type UnspecifiedCNS