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General NPI Number Information
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NPI Number | 1962647610
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Entity Type | Individual
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Provider Name | JOHN D MARINO FNP
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Gender | Male
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 1585 S RANGE AVE
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-5201
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Country | US
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Telephone | 225-791-0002
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT 960139
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City | OKLAHOMA CITY
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State | OK
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Zip | 73196-0139
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Country | US
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Telephone | 877-485-4474
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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 | 05610 APRN
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 100696 RN
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License Number State | LA
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