Provider Demographics
NPI:1548369481
Name:WYER, MARIANNE M (NP)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:M
Last Name:WYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 CAPE RD
Mailing Address - Street 2:
Mailing Address - City:LIMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04049-3923
Mailing Address - Country:US
Mailing Address - Phone:207-793-8663
Mailing Address - Fax:
Practice Address - Street 1:200 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2418
Practice Address - Country:US
Practice Address - Phone:207-772-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER031996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner