Provider Demographics
NPI:1225502511
Name:MARINO, JANELLE WOLEK (NP-C)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:WOLEK
Last Name:MARINO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2805
Mailing Address - Country:US
Mailing Address - Phone:719-539-5338
Mailing Address - Fax:719-539-5339
Practice Address - Street 1:515 E 1ST STREET
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2106
Practice Address - Country:US
Practice Address - Phone:719-539-5338
Practice Address - Fax:195-395-3397
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily