Provider Demographics
NPI:1215090816
Name:MARINELLI, CHARITY JOYCE
Entity type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:JOYCE
Last Name:MARINELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 DYKE RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-3602
Mailing Address - Country:US
Mailing Address - Phone:810-512-4712
Mailing Address - Fax:
Practice Address - Street 1:6507 DYKE RD
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:MI
Practice Address - Zip Code:48001-3602
Practice Address - Country:US
Practice Address - Phone:810-512-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204443-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02211118Medicaid