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General NPI Number Information
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NPI Number | 1841239258
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Entity Type | Individual
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Provider Name | ROSEANNE M MARRA FNP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3175 LENOX PARK BLVD SUITE 412
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City | MEMPHIS
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State | TN
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Zip | 38115-4260
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Country | US
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Telephone | 901-273-2368
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Fax | 901-273-2351
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Provider Business Mailing Address
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Address Line | 3175 LENOX PARK BLVD SUITE 412
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City | MEMPHIS
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State | TN
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Zip | 38115-4260
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Country | US
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Telephone | 901-273-2368
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Fax | 901-273-2351
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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 | NP 15363
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License Number State | CA
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