Provider Demographics
NPI:1407816697
Name:MARENCO, DANIELLE R (APRN)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:R
Last Name:MARENCO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 HAYNES ST FL 2
Mailing Address - Street 2:MEDICAL ONCOLOGY AND BLOOD DISORDERS, LLP
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4113
Mailing Address - Country:US
Mailing Address - Phone:860-646-0670
Mailing Address - Fax:860-643-9388
Practice Address - Street 1:345 N MAIN ST STE 318
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2508
Practice Address - Country:US
Practice Address - Phone:860-527-5803
Practice Address - Fax:860-525-3687
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP42175Medicare UPIN