| Organization Name: | MARIANNE DECAIN TARRAZA NP, LLC |
| NPI Number: | 1932454907 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER S FOURNIER (CREDENTIALING BILLING REP) |
| Mailing Address: | 1000 Shore Rd Building #326 Cape Elizabeth |
| State: | ME US |
| Postal Code: | 041071916 |
| Phone Number: | 2073121063 |
| Fax Number: | 2073755165 |
| NPI Enumeration Date: | 07/17/2012 |
| NPI Last Update Date: | 07/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | CNP81164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |