Provider Demographics
NPI:1548351828
Name:DEEMEDIO, MARCY K (APN)
Entity type:Individual
Prefix:MS
First Name:MARCY
Middle Name:K
Last Name:DEEMEDIO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STOCKLEY ST OFC
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-1846
Mailing Address - Country:US
Mailing Address - Phone:302-227-3172
Mailing Address - Fax:302-227-5176
Practice Address - Street 1:500 STOCKLEY ST OFC
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-1846
Practice Address - Country:US
Practice Address - Phone:302-227-3172
Practice Address - Fax:302-227-5176
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ0000225363L00000X, 363LP0200X
DEL1-0028892163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0056014Medicaid
MD4067525Medicaid
Q36316Medicare UPIN
NJ0056014Medicaid