Basic Information
| Provider Information | |||||||||
| NPI: | 1790180107 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCHIONNA | ||||||||
| FirstName: | ANTONELLA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 2153 DEPT 1947 | ||||||||
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| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352870001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012924562 | ||||||||
| FaxNumber: | 6019746237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1887 SPILLWAY RD | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390476066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019925532 | ||||||||
| FaxNumber: | 6019925547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2014 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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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 | R876088 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.