Individual
MS. MARIANNE F. VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
354 AIRPORT RD, STONINGTON, ME 04681-3217
(207) 367-2311
(207) 367-2805
Mailing address
354 AIRPORT RD, STONINGTON, ME 04681-3217
(207) 367-2311
(207) 367-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-840
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689610776
—
ME
Enumeration date
06/20/2006
Last updated
12/21/2020
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