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General NPI Number Information
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NPI Number | 1235190596
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Entity Type | Individual
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Provider Name | JOSEPH F. MARRA JR. CRNP
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 400 HARDING ST
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City | CLAYTON
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State | NM
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Zip | 88415-3339
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Country | US
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Telephone | 814-943-6111
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Fax | 914-943-6118
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Provider Business Mailing Address
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Address Line | 400 HARDING ST
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City | CLAYTON
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State | NM
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Zip | 88415-3339
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Country | US
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Telephone | 814-943-6111
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Fax | 914-943-6118
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP007906
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | SP007906
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-01916
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License Number State | NM
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