MEDICARE: MARIE LUCETTE LAIME-MOMPLAISIR

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
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1871080085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE LUCETTE LAIME-MOMPLAISIR

Provider Business Mailing Address
First Line	:	2420 GLENWOOD RD APT 3J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 GLENWOOD RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2642
Country	:	US
Telephone Number	:	718-859-2525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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