Provider Demographics
NPI:1760187330
Name:MARENCO, ABIGAIL (APN)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MARENCO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MARLTON PIKE E STE V107
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4212
Mailing Address - Country:US
Mailing Address - Phone:856-751-4127
Mailing Address - Fax:888-745-4079
Practice Address - Street 1:1930 MARLTON PIKE E STE V107
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4212
Practice Address - Country:US
Practice Address - Phone:856-751-4127
Practice Address - Fax:888-745-4079
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01463700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health