Provider Demographics
NPI:1689986846
Name:MARSH, DANIELE C PERRELLI (CNP)
Entity Type:Individual
Prefix:
First Name:DANIELE
Middle Name:C PERRELLI
Last Name:MARSH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44842-1247
Mailing Address - Country:US
Mailing Address - Phone:419-994-0212
Mailing Address - Fax:419-994-0215
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44842-1247
Practice Address - Country:US
Practice Address - Phone:419-994-0212
Practice Address - Fax:419-994-0215
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-04
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 11616-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3091238Medicaid
OH3091238Medicaid