Provider Demographics
NPI:1194727172
Name:DIMAGGIO, MARLEENA (APRN)
Entity type:Individual
Prefix:
First Name:MARLEENA
Middle Name:
Last Name:DIMAGGIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 KINGS HWY E STE 106
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4871
Mailing Address - Country:US
Mailing Address - Phone:203-819-1203
Mailing Address - Fax:203-819-1203
Practice Address - Street 1:501 KINGS HWY E STE 106
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4871
Practice Address - Country:US
Practice Address - Phone:203-819-1203
Practice Address - Fax:203-819-1203
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ37946Medicare UPIN
CT500001423Medicare PIN