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NPI Code Detail

MEDICARE: MS. DANA L MARINO

MEDICARE: MS. DANA L MARINO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner4704202282MI
2363LA2200XAdult Health Nurse Practitioner4704202282MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14704202282OTHERMIBOARD OF NURSING

General Provider Information

NPI Number : 1295982536
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DANA L MARINO
Provider Business Mailing Address
First Line : 1226 COLORADO AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-3916
Country : US
Telephone Number : 616-890-3981
Fax Number :
Provider Business Practice Location Address
First Line : 1241 E DYER RD STE 145
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-5694
Country : US
Telephone Number : 888-306-0615
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 02/21/2017

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