Provider Demographics
NPI:1174248041
Name:BAZILE, MARIE LUNIE
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LUNIE
Last Name:BAZILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:SOUTH LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01561
Mailing Address - Country:US
Mailing Address - Phone:508-510-0003
Mailing Address - Fax:
Practice Address - Street 1:8 OETMAN WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-2866
Practice Address - Country:US
Practice Address - Phone:508-510-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2022056568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily