Healthcare Provider Details

I. General information

NPI: 1326394941
Provider Name (Legal Business Name): JANELLE MARIE HOOVER MARINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 S MARKET ST
MARTINSBURG PA
16662-1005
US

IV. Provider business mailing address

429 S MARKET ST
MARTINSBURG PA
16662-1005
US

V. Phone/Fax

Practice location:
  • Phone: 814-793-2104
  • Fax:
Mailing address:
  • Phone: 814-793-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN573678
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: