Provider Demographics
NPI:1952704215
Name:MAINE, MARJORIE (NP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MAINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:MAINE- NYARKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3336 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8124
Mailing Address - Country:US
Mailing Address - Phone:570-844-0125
Mailing Address - Fax:
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-839-8754
Practice Address - Fax:570-839-1079
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014990363L00000X
NYF380966363LP0200X
PASP024964363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics