Provider Demographics
NPI:1891414538
Name:MARCANO, APRIL RAEANNE
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:RAEANNE
Last Name:MARCANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:RAEANNE
Other - Last Name:RYERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1602 GENEVIEVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-4623
Mailing Address - Country:US
Mailing Address - Phone:909-780-0228
Mailing Address - Fax:
Practice Address - Street 1:1100 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3524
Practice Address - Country:US
Practice Address - Phone:909-893-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA723847164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse