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NPI Code Detail

MEDICARE: MARNIE PEALO

MEDICARE: MARNIE PEALO
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
1164W00000XLicensed Practical Nurse291135NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1291135OTHERNYLICENSE

General Provider Information

NPI Number : 1821546086
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARNIE PEALO
Provider Business Mailing Address
First Line : 14 MAIDEN LN
Second Line :
City : PENN YAN
State : NY
Zip : 14527-1208
Country : US
Telephone Number : 315-531-9102
Fax Number : 315-531-9103
Provider Business Practice Location Address
First Line : 7150 MAIN ST
Second Line :
City : OVID
State : NY
Zip : 14521-9401
Country : US
Telephone Number : 607-403-0065
Fax Number : 607-403-0093
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2016
Last Update Date : 09/16/2016

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Directions to “ MARNIE PEALO ” Practice Location

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