Provider Demographics
NPI:1205020062
Name:TERRIGNO, MARISA CHRISTINE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:CHRISTINE
Last Name:TERRIGNO
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD STE C302
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3338
Mailing Address - Country:US
Mailing Address - Phone:440-816-4394
Mailing Address - Fax:
Practice Address - Street 1:7255 OLD OAK BLVD STE C302
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3338
Practice Address - Country:US
Practice Address - Phone:440-816-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09506363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000552243OtherANTHEM BLUE CROSS BLUE SHIELD
OH2851230Medicaid
OH2851230Medicaid