Basic Information
| Provider Information | |||||||||
| NPI: | 1104363142 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARMARO | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | THULIN | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722340813 | ||||||||
| Practice Location | |||||||||
| Address1: | 8196 WALNUT HILL LN STE 100 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752317001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147394175 | ||||||||
| FaxNumber: | 2149874161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2017 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP133087 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | P01932339 | 01 | TX | RAILROAD | OTHER | 368255101 | 05 | TX | MEDICAID |