Provider Demographics
NPI:1245345669
Name:CESAR, MARLENE (DNP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:CESAR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 HUCKLEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8502
Mailing Address - Country:US
Mailing Address - Phone:786-322-0132
Mailing Address - Fax:
Practice Address - Street 1:2442 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8910
Practice Address - Country:US
Practice Address - Phone:786-322-0132
Practice Address - Fax:610-758-8013
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO11573363LF0000X
FLARNP3085972363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306140000Medicaid
FL306140000Medicaid