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General NPI Number Information
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NPI Number | 1821546086
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Entity Type | Individual
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Provider Name | MARNIE PEALO
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Gender | Female
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 7150 MAIN ST
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City | OVID
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State | NY
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Zip | 14521-9401
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Country | US
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Telephone | 607-403-0065
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Fax | 607-403-0093
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Provider Business Mailing Address
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Address Line | 14 MAIDEN LN
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City | PENN YAN
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State | NY
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Zip | 14527-1208
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Country | US
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Telephone | 315-531-9102
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Fax | 315-531-9103
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 291135
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License Number State | NY
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