MEDICARE: NICOLE MARENO PHD, RN

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
1	163W00000X	Registered Nurse	201819	GA

General Provider Information

NPI Number	:	1679055776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARENO PHD, RN

Provider Business Mailing Address
First Line	:	1266 W PACES FERRY RD NW # 179
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2306
Country	:	US
Telephone Number	:	619-890-5461
Fax Number	:

Provider Business Practice Location Address
First Line	:	3197 RILMAN DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2224
Country	:	US
Telephone Number	:	619-890-5461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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