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General NPI Number Information
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NPI Number | 1023443975
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Entity Type | Individual
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Provider Name | MARC THERRIEN
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Gender | Male
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 102 RUSSET LN
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City | SYRACUSE
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State | NY
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Zip | 13209-2010
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Country | US
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Telephone | 315-263-0526
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Fax |
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Provider Business Mailing Address
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Address Line | 102 RUSSET LN
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City | SYRACUSE
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State | NY
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Zip | 13209-2010
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Country | US
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Telephone | 315-263-0526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 568620
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License Number State | NY
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