Provider Demographics
NPI:1356539266
Name:NEVEU, MARIKO TANSEY (PA-C)
Entity type:Individual
Prefix:
First Name:MARIKO
Middle Name:TANSEY
Last Name:NEVEU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIKO
Other - Middle Name:TANSEY
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:60 BAY SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1384
Mailing Address - Country:US
Mailing Address - Phone:401-246-1300
Mailing Address - Fax:401-289-2582
Practice Address - Street 1:60 BAY SPRING AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1384
Practice Address - Country:US
Practice Address - Phone:401-246-1300
Practice Address - Fax:401-289-2582
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00942363A00000X
MAPA2412363A00000X
TX08137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant