Provider Demographics
NPI:1396474425
Name:MARENCO, DEBBIE MICHELL (RN)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:MICHELL
Last Name:MARENCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2440
Mailing Address - Country:US
Mailing Address - Phone:321-438-2241
Mailing Address - Fax:
Practice Address - Street 1:4640 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4355
Practice Address - Country:US
Practice Address - Phone:321-438-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95249606163W00000X
FL9559753163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse