Provider Demographics
NPI:1982695391
Name:MARLEY-DEROSIER, TERRY A (WHCNP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:MARLEY-DEROSIER
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0918
Mailing Address - Country:US
Mailing Address - Phone:207-947-5337
Mailing Address - Fax:207-947-9163
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-947-5337
Practice Address - Fax:207-947-9163
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER019043363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7493084OtherAETNA NON-HMO
MEMN3827OtherHARVARD PILGRIM
ME040638OtherBLUE CROSS BLUE SHIELD
ME2351291OtherAETNA HMO
MEMN3827OtherHARVARD PILGRIM
ME2351291OtherAETNA HMO