Provider Demographics
NPI:1598993529
Name:DOUGLAS, MARIANNE (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 EAST GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2218
Mailing Address - Country:US
Mailing Address - Phone:315-472-2200
Mailing Address - Fax:315-472-4108
Practice Address - Street 1:2118 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2218
Practice Address - Country:US
Practice Address - Phone:315-472-2200
Practice Address - Fax:315-472-4108
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY534536-1163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery