Marnie Pealo

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

291135 Issued in NY

Practice address

7150 Main St
Ovid, NY 14521-9401

Phone

(607) 403-0065

Fax

(607) 403-0093

NPI assigned

Sep 16, 2016

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 16, 2016.

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473984000000",
    "number": "1821546086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MAIDEN LN",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271208",
            "telephone_number": "315-531-9102",
            "fax_number": "315-531-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 MAIN ST",
            "city": "OVID",
            "state": "NY",
            "postal_code": "145219401",
            "telephone_number": "607-403-0065",
            "fax_number": "607-403-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEALO",
        "first_name": "MARNIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-16",
        "last_updated": "2016-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "291135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "291135",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Ovid, NY
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; 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.