Provider Demographics
NPI:1295735512
Name:MARCOUX, ANNE YVONNE (NP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:YVONNE
Last Name:MARCOUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HIGHLAND AVE SUITE 2
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:978-463-7770
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-463-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3182975Medicaid
MANP3119Medicare ID - Type Unspecified
MA3182975Medicaid