Provider Demographics
NPI:1508135492
Name:PANZA, MARCIA DARRELEE (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:DARRELEE
Last Name:PANZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WEST HURLEY RJOAD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498
Mailing Address - Country:US
Mailing Address - Phone:845-679-2316
Mailing Address - Fax:
Practice Address - Street 1:8 WEST HURLEY RJOAD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498
Practice Address - Country:US
Practice Address - Phone:845-679-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280305163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool