Healthcare Provider Details

I. General information

NPI: 1790875169
Provider Name (Legal Business Name): MARCIA L DENINE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 EDGARTOWN VINEYARD HAVEN RD
EDGARTOWN MA
02539-6941
US

IV. Provider business mailing address

PO BOX 1619
WEST TISBURY MA
02575-1619
US

V. Phone/Fax

Practice location:
  • Phone: 508-627-5797
  • Fax: 508-627-5799
Mailing address:
  • Phone: 508-627-5797
  • Fax: 508-627-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number250377
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: