=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447276431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA THERESA MARINUCCI NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 09/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1527 FOREST GROVE RD
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-1865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-697-7490
-----------------------------------------------------
Fax | 856-697-7494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 HANCOCK DR
-----------------------------------------------------
City | MULLICA HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08062-1828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-223-0908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00057800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------