Provider Demographics
NPI:1740922764
Name:CLARILLO, MARIOLYN (RN)
Entity type:Individual
Prefix:
First Name:MARIOLYN
Middle Name:
Last Name:CLARILLO
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 1:2543 CORINTH DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4783
Mailing Address - Country:US
Mailing Address - Phone:312-401-5755
Mailing Address - Fax:
Practice Address - Street 1:2543 CORINTH DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4783
Practice Address - Country:US
Practice Address - Phone:312-401-5755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC077661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty