Provider Demographics
NPI:1659689545
Name:SILK, MARIELLE M (APRN)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:M
Last Name:SILK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARIELLE
Other - Middle Name:M
Other - Last Name:LESNEVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9840
Practice Address - Street 1:370 HWY 35
Practice Address - Street 2:SUITE 101
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5922
Practice Address - Country:US
Practice Address - Phone:732-758-0048
Practice Address - Fax:732-758-0052
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00447600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily