Provider Demographics
NPI:1548209661
Name:MARINACCIO, BARBARA DAMON (PNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:DAMON
Last Name:MARINACCIO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2741
Mailing Address - Country:US
Mailing Address - Phone:781-216-2115
Mailing Address - Fax:781-216-2194
Practice Address - Street 1:9 HOPE AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2741
Practice Address - Country:US
Practice Address - Phone:781-216-2115
Practice Address - Fax:781-216-2194
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163845363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner