Provider Demographics
NPI:1740758960
Name:MIGLIORISI, MARIELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:MIGLIORISI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EISENHOWER CT
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3401
Mailing Address - Country:US
Mailing Address - Phone:917-533-2219
Mailing Address - Fax:
Practice Address - Street 1:2 EISENHOWER CT
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3401
Practice Address - Country:US
Practice Address - Phone:917-533-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00871300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner