Provider Demographics
NPI:1598429870
Name:KREITER, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KREITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5634
Mailing Address - Country:US
Mailing Address - Phone:401-480-3792
Mailing Address - Fax:
Practice Address - Street 1:111 SALEM TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7403
Practice Address - Country:US
Practice Address - Phone:860-886-0023
Practice Address - Fax:860-886-0024
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN63510163W00000X
CT011717363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse