Healthcare Provider Details

I. General information

NPI: 1649169145
Provider Name (Legal Business Name): MARIELLE LEIGH MCDERMOTT DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0145
  • Fax:
Mailing address:
  • Phone: 910-343-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number316538
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024093798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: