Basic Information
| Provider Information | |||||||||
| NPI: | 1164559233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSTON-NELSON | ||||||||
| FirstName: | JANETTE | ||||||||
| MiddleName: | ARLENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NELSON | ||||||||
| OtherFirstName: | JANETTE | ||||||||
| OtherMiddleName: | ARLENE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | CHRISTIANA HOSP 4755 OGLETOWN-STANTON RD | ||||||||
| Address2: | C/O ACADEMIC AFFAIRS, SUITE 2A00; P.O BOX 6001 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197180001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027334200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CHRISTIANA HOSP 4755 OGLETOWN-STANTON RD | ||||||||
| Address2: | C/O ACADEMIC AFFAIRS, SUITE 2A00; | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197180001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027334200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/24/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C-1-0007066 | DE | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1000027191 | 05 | DE | MEDICAID |