1225502511 NPI number — JANELLE WOLEK MARINO NP-C

Table of content: JANELLE WOLEK MARINO NP-C (NPI 1225502511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225502511 NPI number — JANELLE WOLEK MARINO NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARINO
Provider First Name:
JANELLE
Provider Middle Name:
WOLEK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225502511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 E 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALIDA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81201-2805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-539-5338
Provider Business Mailing Address Fax Number:
719-539-5339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E 1ST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALIDA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81201-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-539-5338
Provider Business Practice Location Address Fax Number:
195-395-3397
Provider Enumeration Date:
01/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  11000187 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104166600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com