Marissa Autumn Marino, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP025286 Issued in PA

Practice address

1102 Highway 315 Blvd
Wilkes Barre, PA 18702-6943

Phone

(570) 235-1470

Fax

(570) 550-9256

NPI assigned

Feb 12, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• My Kids Pediatric Partners PC

  • Pediatrics Physician
  • Wilkes Barre, PA
  • NPI 1407355472
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644624000000",
    "number": "1699420232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 HIGHWAY 315 BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026943",
            "telephone_number": "570-235-1470",
            "fax_number": "570-550-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 HIGHWAY 315 BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026943",
            "telephone_number": "570-235-1470",
            "fax_number": "570-550-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINO",
        "first_name": "MARISSA",
        "middle_name": "AUTUMN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-12",
        "last_updated": "2022-02-12",
        "certification_date": "2022-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN638114",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP025286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Margavage, RN
• Robin Michelle Marichak, ATHLETIC TRAINER
• David R. Mariner, M.D.
• Angela Marie Marino, RD, LDN
• Cara Marino, OT
• Sacha Marino, CRNP
• Catherine Marion, COTA/L
• Vanessa Anne Markle, PHARMACIST
• Hannah Markley
• Paul Markwith, PT

• Family Nurse Practitioner in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.