Provider Demographics
NPI:1134850902
Name:LUCIEN-JEAN, MARIE-RENEE DARLINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MARIE-RENEE
Middle Name:DARLINE
Last Name:LUCIEN-JEAN
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 1:543 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-4111
Mailing Address - Country:US
Mailing Address - Phone:617-212-0711
Mailing Address - Fax:
Practice Address - Street 1:252 GROVE STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:617-212-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262840363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2262840OtherN/A