Healthcare Provider Details

I. General information

NPI: 1922498658
Provider Name (Legal Business Name): MARIANNE DYKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HIGH ST OLIVER TOWER, 18TH FLOOR
BOSTON MA
02110-2704
US

IV. Provider business mailing address

125 HIGH ST OLIVER TOWER, 18TH FLOOR
BOSTON MA
02110-2704
US

V. Phone/Fax

Practice location:
  • Phone: 617-526-8888
  • Fax: 617-526-0188
Mailing address:
  • Phone: 617-526-8888
  • Fax: 617-526-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number163624
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: