Provider Demographics
NPI:1457922908
Name:EUSTACHE, MARIE M (NP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:EUSTACHE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 TRADECENTER STE G700
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7471
Mailing Address - Country:US
Mailing Address - Phone:781-287-8722
Mailing Address - Fax:781-287-8772
Practice Address - Street 1:100 TRADECENTER STE G700
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7471
Practice Address - Country:US
Practice Address - Phone:781-287-8722
Practice Address - Fax:781-287-8772
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2301634363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health