Individual
JANET MARIE MARINELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
40 CAPRI BLVD STE 102, LAKE HAVASU CITY, AZ 86403-5661
(602) 955-1000
(602) 508-4830
Mailing address
4800 N 22ND ST STE 210, PHOENIX, AZ 85016-4963
(602) 955-1000
(602) 508-4830
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3604
AZ
363AM0700X
Medical Physician Assistant
3604
AZ
363AS0400X
Surgical Physician Assistant
3604
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3604
LICENSE
AZ
05
—
378599
—
AZ
Enumeration date
04/10/2007
Last updated
05/04/2023
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