Provider Demographics
NPI:1124221072
Name:CARON, MARJORIE ANN (RN, CDE)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANN
Last Name:CARON
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3607
Mailing Address - Country:US
Mailing Address - Phone:402-592-2793
Mailing Address - Fax:
Practice Address - Street 1:8601 W DODGE RD
Practice Address - Street 2:SUITE # 30
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3457
Practice Address - Country:US
Practice Address - Phone:402-354-8797
Practice Address - Fax:402-354-5651
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20587163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE20587OtherRN LICENSE