Provider Demographics
NPI:1285617753
Name:MAROULIS, ANN L (MSN NP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:L
Last Name:MAROULIS
Suffix:
Gender:F
Credentials:MSN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2130 HIGHWAY 35
Mailing Address - Street 2:321C
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1010
Mailing Address - Country:US
Mailing Address - Phone:732-974-6700
Mailing Address - Fax:732-974-6707
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:321C
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-974-6700
Practice Address - Fax:732-974-6707
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN04838000363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS57526Medicare UPIN
NJ006297P15Medicare PIN