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General NPI Number Information
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NPI Number | 1023774411
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Entity Type | Individual
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Provider Name | MARIELLE NASTA APN
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Gender | Female
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 140 FRANKLIN TPKE STE 6A
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City | WALDWICK
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State | NJ
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Zip | 07463-1836
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Country | US
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Telephone | 201-447-3603
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Fax |
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Provider Business Mailing Address
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Address Line | 227 VAN SAUN DR
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City | RIVER EDGE
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State | NJ
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Zip | 07661-1715
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Country | US
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Telephone | 201-832-5365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR16248700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ01235500
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License Number State | NJ
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