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NPI Code Detail

MEDICARE: MARQUETTA WASHINGTON LPN

MEDICARE:   MARQUETTA  WASHINGTON  LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse315389NY

General Provider Information

NPI Number : 1427500032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARQUETTA WASHINGTON LPN
Provider Business Mailing Address
First Line : PO BOX 8111
Second Line :
City : NEW HAVEN
State : CT
Zip : 06530-0111
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 547 SAW MILL RIVER RD STE 3A
Second Line : SUITE 3A
City : ARDSLEY
State : NY
Zip : 10502-2142
Country : US
Telephone Number : 914-510-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2016
Last Update Date : 10/30/2016

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Directions to “ MARQUETTA WASHINGTON LPN” Practice Location

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