Provider Demographics
NPI:1942399381
Name:MARCIANO, CAROL SERENA (CRNFA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SERENA
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 E KACHINA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3431
Mailing Address - Country:US
Mailing Address - Phone:480-213-6838
Mailing Address - Fax:480-961-6084
Practice Address - Street 1:3616 E KACHINA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3431
Practice Address - Country:US
Practice Address - Phone:480-213-6838
Practice Address - Fax:480-961-6084
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN057633163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ18074026OtherSTATE FUND OF ARIZONA
AZAZ0166920OtherBLUE CROSS BLUE SHIELD