Provider Demographics
NPI:1679382303
Name:MARCINIAK, CHRISTY LEE (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEE
Last Name:MARCINIAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:LEE
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 ROMANCOKE RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2857
Mailing Address - Country:US
Mailing Address - Phone:443-496-1291
Mailing Address - Fax:
Practice Address - Street 1:219 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2913
Practice Address - Country:US
Practice Address - Phone:410-822-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211658363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology