Provider Demographics
NPI:1033205695
Name:MARASCALCO-KING, RITA M (ANP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:MARASCALCO-KING
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:PARTNERS IN WELLNESS
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130
Mailing Address - Country:US
Mailing Address - Phone:318-813-2225
Mailing Address - Fax:318-813-2239
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:PARTNERS IN WELLNESS
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71130
Practice Address - Country:US
Practice Address - Phone:318-813-2225
Practice Address - Fax:318-813-2239
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO1228363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAQ72431Medicare UPIN
LA4H947F600Medicare PIN