Healthcare Provider Details

I. General information

NPI: 1184058364
Provider Name (Legal Business Name): MARCELINA DAMASO ACNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2013
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 FOULK RD
GARNET VALLEY PA
19060-1701
US

IV. Provider business mailing address

2377 HAVERFORD RD 2ND FLOOR
ARDMORE PA
19003-2912
US

V. Phone/Fax

Practice location:
  • Phone: 610-361-0070
  • Fax: 610-361-0071
Mailing address:
  • Phone: 239-822-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberF430741-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP013827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: