Basic Information
| Provider Information | |||||||||
| NPI: | 1861868481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAINER | ||||||||
| FirstName: | MARIANNE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 EXECUTIVE CIR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126911533 | ||||||||
| FaxNumber: | 9126911953 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 EXECUTIVE CIR | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314063345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126911533 | ||||||||
| FaxNumber: | 9126911953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN209207 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.