Provider Demographics
NPI:1346494432
Name:MARESCA, JOANNE SEIDEL (RN, NNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:SEIDEL
Last Name:MARESCA
Suffix:
Gender:F
Credentials:RN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 HORATIO AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3245
Mailing Address - Country:US
Mailing Address - Phone:516-354-3290
Mailing Address - Fax:516-488-8387
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:LAWRENCE HOSPITAL CENTER
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-787-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294472-1163W00000X
NY350151-1363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse