Provider Demographics
NPI:1104114792
Name:MARCHENKO, CAITLIN JULIA (NP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:JULIA
Last Name:MARCHENKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:JULIA
Other - Last Name:CHADWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:46 OBERY ST
Mailing Address - Street 2:DEPT OF NEUROLOGY AND NEUROSURGERY
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2130
Mailing Address - Country:US
Mailing Address - Phone:508-210-5925
Mailing Address - Fax:
Practice Address - Street 1:46 OBERY ST
Practice Address - Street 2:DEPT OF NEUROLOGY AND NEUROSURGERY
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2130
Practice Address - Country:US
Practice Address - Phone:508-210-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily