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General NPI Number Information
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NPI Number | 1306198965
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Entity Type | Individual
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Provider Name | LORENA KIMBERLY MARRA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 269 RIVERSIDE DR
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2726
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Country | US
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Telephone | 607-729-9327
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Fax |
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Provider Business Mailing Address
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Address Line | 778 COLESVILLE RD
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City | BINGHAMTON
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State | NY
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Zip | 13904-3416
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Country | US
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Telephone | 607-724-6907
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F337578-1
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License Number State | NY
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