Provider Demographics
NPI:1396408498
Name:MARINO, CHRISTINEA (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINEA
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-6840
Mailing Address - Country:US
Mailing Address - Phone:304-906-8393
Mailing Address - Fax:
Practice Address - Street 1:122 OKATIE CENTER BLVD N
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3781
Practice Address - Country:US
Practice Address - Phone:304-906-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25497363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner