Provider Demographics
NPI:1598759086
Name:MARSICO, CHARLENE ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:ANN
Last Name:MARSICO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2413 RANSOM RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9570
Mailing Address - Country:US
Mailing Address - Phone:570-586-2515
Mailing Address - Fax:
Practice Address - Street 1:5 MORGAN HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2641
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:570-969-9280
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003395B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500005802OtherRAILROAD MEDICARE
PA50076461OtherCAPITAL BLUE CROSS
PA018463OtherBLUE CARE
PA101217060001Medicaid
PA500005802OtherRAILROAD MEDICARE