Basic Information
Provider Information
NPI: 1548737307
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CADENELLI
FirstName: MARIJKE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1234
Address2:  
City: SAINT HELENS
State: OR
PostalCode: 970518234
CountryCode: US
TelephoneNumber: 5034382229
FaxNumber:  
Practice Location
Address1: 185 N 4TH ST
Address2:  
City: SAINT HELENS
State: OR
PostalCode: 970511535
CountryCode: US
TelephoneNumber: 5033664540
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/30/2018
LastUpdateDate: 10/30/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WA0400X201390374RNORY Nursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)

No ID Information.


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