Provider Demographics
NPI:1013296961
Name:TUMARELLO, MARIAH ANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:ANNE
Last Name:TUMARELLO
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:P.O. BX 328
Mailing Address - Street 2:1626 SPEONK RIVERHEAD RD
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0328
Mailing Address - Country:US
Mailing Address - Phone:631-745-5665
Mailing Address - Fax:
Practice Address - Street 1:1626 SPEONK RIVERHEAD RD
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972-0328
Practice Address - Country:US
Practice Address - Phone:631-745-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY547755-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse