Healthcare Provider Details

I. General information

NPI: 1235934043
Provider Name (Legal Business Name): MARLA DEANGELIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLA MARINI

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 LOOKOUT AVE
NATICK MA
01760-4135
US

IV. Provider business mailing address

41 W CENTRAL ST
NATICK MA
01760-4503
US

V. Phone/Fax

Practice location:
  • Phone: 508-960-5747
  • Fax: 508-969-9573
Mailing address:
  • Phone: 508-960-5747
  • Fax: 508-969-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN269392
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: