Provider Demographics
NPI:1568769461
Name:MARINO, CAROL (L P N)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:L P N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OSAGE CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1517
Mailing Address - Country:US
Mailing Address - Phone:516-754-7412
Mailing Address - Fax:
Practice Address - Street 1:1 OSAGE CT
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1517
Practice Address - Country:US
Practice Address - Phone:516-754-7412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299135-1DUP164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse