Healthcare Provider Details

I. General information

NPI: 1629332929
Provider Name (Legal Business Name): MARILYN LAURENT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 LINDEN BLVD APT. C12
BROOKLYN NY
11226-3642
US

IV. Provider business mailing address

164 LINDEN BLVD APT C12
BROOKLYN NY
11226-3650
US

V. Phone/Fax

Practice location:
  • Phone: 347-348-9904
  • Fax:
Mailing address:
  • Phone: 347-348-9904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number908237-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number310302-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: