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General NPI Number Information
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NPI Number | 1902661416
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Entity Type | Individual
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Provider Name | CARLA RODRIGUES MARRELLI
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Gender | Female
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 11050 MT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-2603
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Country | US
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Telephone | 315-772-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 9693A FITZSIMMONS LOOP
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City | FORT DRUM
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State | NY
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Zip | 13603-3208
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Country | US
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Telephone | 845-633-3117
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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 | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 434652
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 746232
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 332840
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 033168
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License Number State | NY
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