Healthcare Provider Details

I. General information

NPI: 1649541913
Provider Name (Legal Business Name): DIDENA S MARSEILLE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 12TH AVE
HUNTINGTN STA NY
11746-2104
US

IV. Provider business mailing address

21 12TH AVE
HUNTINGTN STA NY
11746-2104
US

V. Phone/Fax

Practice location:
  • Phone: 631-547-1830
  • Fax: 631-547-1830
Mailing address:
  • Phone: 631-547-1830
  • Fax: 631-547-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number570364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: