Provider Demographics
NPI:1427074848
Name:CILIBERTO, MARIE M (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:M
Last Name:CILIBERTO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3113
Mailing Address - Country:US
Mailing Address - Phone:360-876-5725
Mailing Address - Fax:
Practice Address - Street 1:2025 WHEATON WAY
Practice Address - Street 2:STE 202
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4300
Practice Address - Country:US
Practice Address - Phone:360-373-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002126363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9608076Medicaid
WA9608076Medicaid
WAR29259Medicare UPIN