Provider Demographics
NPI:1578088712
Name:MARENCIK, MARILYN GRACE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:GRACE
Last Name:MARENCIK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:GRACE
Other - Last Name:PURVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 KING OF PRUSSIA RD
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5227
Mailing Address - Country:US
Mailing Address - Phone:610-902-2450
Mailing Address - Fax:610-902-2466
Practice Address - Street 1:250 KING OF PRUSSIA RD
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5235
Practice Address - Country:US
Practice Address - Phone:215-662-7366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily