Healthcare Provider Details

I. General information

NPI: 1497208847
Provider Name (Legal Business Name): MARILYN P LARUE FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILYN P O'MERY

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FAHY ST STE 201
BELFAST ME
04915-6029
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-505-4491
  • Fax: 207-505-4496
Mailing address:
  • Phone: 207-404-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP211176
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP211176
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016245
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.19207
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN81605NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: