Provider Demographics
NPI:1023774411
Name:NASTA, MARIELLE (APN)
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:NASTA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 VAN SAUN DR
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1715
Mailing Address - Country:US
Mailing Address - Phone:201-832-5365
Mailing Address - Fax:
Practice Address - Street 1:140 FRANKLIN TPKE STE 6A
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1836
Practice Address - Country:US
Practice Address - Phone:201-447-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16248700163W00000X
NJ26NJ01235500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse