Provider Demographics
NPI:1306198965
Name:MARRA, LORENA KIMBERLY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:KIMBERLY
Last Name:MARRA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 COLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-3416
Mailing Address - Country:US
Mailing Address - Phone:607-724-6907
Mailing Address - Fax:
Practice Address - Street 1:269 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2726
Practice Address - Country:US
Practice Address - Phone:607-729-9327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337578-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily