Provider Demographics
NPI:1285004853
Name:MAREK, MICHAEL GIOVANNI (CRNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GIOVANNI
Last Name:MAREK
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:117 VIP DR STE 310
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6936
Mailing Address - Country:US
Mailing Address - Phone:724-934-3905
Mailing Address - Fax:724-934-3906
Practice Address - Street 1:117 VIP DR STE 310
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6936
Practice Address - Country:US
Practice Address - Phone:724-934-3905
Practice Address - Fax:724-934-3906
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015183363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health