Provider Demographics
NPI:1548581903
Name:MARINELLI, AMY TERESA (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TERESA
Last Name:MARINELLI
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 1:2135C CROW HILL DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AK
Mailing Address - Zip Code:99824-5003
Mailing Address - Country:US
Mailing Address - Phone:907-365-2112
Mailing Address - Fax:
Practice Address - Street 1:225 FRONT ST
Practice Address - Street 2:202
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1244
Practice Address - Country:US
Practice Address - Phone:907-463-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19925163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse