Provider Demographics
NPI:1710350426
Name:PRODAN, MARYNA (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:PRODAN
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-1412
Mailing Address - Country:US
Mailing Address - Phone:973-399-1002
Mailing Address - Fax:973-375-4837
Practice Address - Street 1:1395 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1412
Practice Address - Country:US
Practice Address - Phone:973-399-1002
Practice Address - Fax:973-375-4837
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00592200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily