Provider Demographics
NPI:1538304423
Name:MARCELLI, JOLENE WIECZOREK (RN)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:WIECZOREK
Last Name:MARCELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:WIECZOREK
Other - Last Name:SPRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4070 W. GILBERT ST.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1678
Mailing Address - Country:US
Mailing Address - Phone:520-744-4872
Mailing Address - Fax:520-744-6028
Practice Address - Street 1:4070 W GILBERT ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1678
Practice Address - Country:US
Practice Address - Phone:520-744-4872
Practice Address - Fax:520-744-6028
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 141731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse