Provider Demographics
NPI:1215334347
Name:SOBERANO, MARILYN IV (HEMODIALYSIS RN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:SOBERANO
Suffix:IV
Gender:F
Credentials:HEMODIALYSIS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07802-0224
Mailing Address - Country:US
Mailing Address - Phone:973-978-7351
Mailing Address - Fax:973-927-1873
Practice Address - Street 1:2105 BARCLAY CT
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1270
Practice Address - Country:US
Practice Address - Phone:973-978-7351
Practice Address - Fax:973-927-1873
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10205000163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis