Provider Demographics
NPI: | 1558451559 |
---|---|
Name: | DIDONNA, MARLO (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARLO |
Middle Name: | |
Last Name: | DIDONNA |
Suffix: | |
Gender: | F |
Credentials: | CRNA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1 FEDERAL ST |
Mailing Address - Street 2: | SUITE SW200 |
Mailing Address - City: | CAMDEN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08103-1088 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-356-4924 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1 COOPER PLZ |
Practice Address - Street 2: | DEPT OF ANESTHESIA |
Practice Address - City: | CAMDEN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08103-1461 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-342-2425 |
Practice Address - Fax: | 856-968-8239 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-13 |
Last Update Date: | 2019-10-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 26NJ00196600 | 367500000X |
NJ | NO116084 | 367500000X |
PA | RN353713L | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 01000736500 | Other | AMERICHOICE |
NJ | NJ00196600 | Other | STATE LICENSE |
NJ | 071082 CK2 | Medicare PIN |