Healthcare Provider Details

I. General information

NPI: 1689638009
Provider Name (Legal Business Name): MARLENE O ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KINGS COUNTY HOSPITAL 451 CLARKSON AVE, E BLDG-6TH FL
BROOKLYN NY
11203
US

IV. Provider business mailing address

14554 229TH ST
SPRINGFIELD GARDENS NY
11413-3923
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-5484
  • Fax: 718-245-3061
Mailing address:
  • Phone: 718-341-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number331458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: