Provider Demographics
NPI:1952428328
Name:MARCOTTE, TERRENCE R (NP MSN)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:R
Last Name:MARCOTTE
Suffix:
Gender:M
Credentials:NP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:995 POTRERO AVE BLDG 80
Mailing Address - Street 2:WARD 86
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2859
Mailing Address - Country:US
Mailing Address - Phone:415-206-3415
Mailing Address - Fax:415-502-4777
Practice Address - Street 1:995 POTRERO AVE BLDG 80
Practice Address - Street 2:WARD 86
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:415-206-3415
Practice Address - Fax:415-502-4777
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 587123163WP2201X
CANPF14255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
095562OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
Q30183Medicare UPIN