Provider Demographics
NPI:1689283947
Name:MARCELLO, JESSICA (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARCELLO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15640 NE FOURTH PLAIN BLVD STE 106 #440
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15640 NE FOURTH PLAIN BLVD STE 106
Practice Address - Street 2:#440
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5141
Practice Address - Country:US
Practice Address - Phone:360-550-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202213702NP-PP363LP0808X
FL9276527163W00000X
WAAP61185664363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse