# MARIANNE DECAIN TARRAZA NP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932454907
- **Authorized official:** JENNIFER S FOURNIER (CREDENTIALING BILLING REP)
- **Authorized official phone:** (207) 312-1063

## Contact information

- **Practice address:** 1000 SHORE RD, BUILDING \#326, CAPE ELIZABETH, ME 04107-1916
- **Practice address phone:** (207) 312-1063
- **Practice address fax:** (207) 375-5165
- **Mailing address:** PO BOX 2328, SOUTH PORTLAND, ME 04116-2328
- **Mailing address phone:** (207) 312-1063
- **Mailing address fax:** (207) 375-5165

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0809X | Adult Psychiatric/Mental Health Registered Nurse | CNP81164 | ME | Yes |

## Other

- **Enumeration date:** 07/17/2012
- **Last updated:** 07/17/2012