Active NPI
Terry A Marley-Derosier, WHCNP
- Women's Health Nurse Practitioner
- Bangor, ME
National Provider Identifier
1982695391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- R019043
- Practice address
- 700 Mount Hope Ave
Suite 420
Bangor, ME 04401-5691 - Phone
- (207) 947-5337
- Fax
- (207) 947-9163
- NPI assigned
- Nov 3, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | R019043 | ME | Primary |
Addresses
Primary practice location
700 Mount Hope Ave
Suite 420
Bangor, ME 04401-5691
Mailing address
PO Box 918
Bangor, ME 04402-0918
Phone (207) 947-5337
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7493084 | Other | ME | AETNA NON-HMO |
| MN3827 | Other | ME | HARVARD PILGRIM |
| 040638 | Other | ME | BLUE CROSS BLUE SHIELD |
| 2351291 | Other | ME | AETNA HMO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R019043 | ME | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Partners LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Belfast, ME
- NPI 1598170987
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184716800000",
"number": "1982695391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 918",
"city": "BANGOR",
"state": "ME",
"postal_code": "044020918",
"telephone_number": "207-947-5337",
"fax_number": "207-947-9163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 MOUNT HOPE AVE",
"address_2": "SUITE 420",
"city": "BANGOR",
"state": "ME",
"postal_code": "044015691",
"telephone_number": "207-947-5337",
"fax_number": "207-947-9163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARLEY-DEROSIER",
"first_name": "TERRY",
"middle_name": "A",
"credential": "WHCNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-03",
"last_updated": "2007-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "ME",
"license": "R019043",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA NON-HMO",
"identifier": "7493084",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "MN3827",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "040638",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "2351291",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.