Healthcare Provider Details

I. General information

NPI: 1053700120
Provider Name (Legal Business Name): AMANDA SUE MARINO C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 CHEW ST FL 1
ALLENTOWN PA
18102-3648
US

IV. Provider business mailing address

700 COVENTRY DR
PHILLIPSBURG NJ
08865-1972
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-1600
  • Fax:
Mailing address:
  • Phone: 908-454-4666
  • Fax: 908-454-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP012936
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: