Healthcare Provider Details

I. General information

NPI: 1679807390
Provider Name (Legal Business Name): MRS. MARCELLA ANNE RANKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 OLD COUNTRY RD
EASTPORT NY
11941-1424
US

IV. Provider business mailing address

366 OLD COUNTRY RD
EASTPORT NY
11941-1424
US

V. Phone/Fax

Practice location:
  • Phone: 631-801-2044
  • Fax:
Mailing address:
  • Phone: 631-801-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number230549-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: