Provider Demographics
NPI:1467891382
Name:VENEGAS, MARCELO ENRIQUE (APRN)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:ENRIQUE
Last Name:VENEGAS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-540-3339
Mailing Address - Fax:502-540-3393
Practice Address - Street 1:5100 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3023
Practice Address - Country:US
Practice Address - Phone:502-968-6226
Practice Address - Fax:502-966-5562
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100247090Medicaid