Provider Demographics
NPI:1861795874
Name:DIMARCO, MARILYN DALE (APRN/FNP)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:DALE
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:APRN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3715 WILLIAMS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3075
Mailing Address - Country:US
Mailing Address - Phone:504-465-4550
Mailing Address - Fax:504-465-8590
Practice Address - Street 1:3715 WILLIAMS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3075
Practice Address - Country:US
Practice Address - Phone:504-465-4550
Practice Address - Fax:504-465-8590
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN085134-AP06262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily