Provider Demographics
NPI:1033654140
Name:IONNO, MARISSA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:NICOLE
Last Name:IONNO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS WAY E STE A3
Mailing Address - Street 2:WASHINGTON PAVILIONS
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2237
Mailing Address - Country:US
Mailing Address - Phone:856-589-3331
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS WAY E STE A3
Practice Address - Street 2:WASHINGTON PAVILIONS
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2237
Practice Address - Country:US
Practice Address - Phone:856-589-3331
Practice Address - Fax:856-589-3416
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00421200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical