Healthcare Provider Details

I. General information

NPI: 1952633950
Provider Name (Legal Business Name): MARIANA RIMBU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 COOPER AVE
GLENDALE NY
11385-6143
US

IV. Provider business mailing address

6430 COOPER AVE
GLENDALE NY
11385-6143
US

V. Phone/Fax

Practice location:
  • Phone: 347-385-6266
  • Fax:
Mailing address:
  • Phone: 347-385-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number529314
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number529314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: