Healthcare Provider Details

I. General information

NPI: 1629450382
Provider Name (Legal Business Name): THATCHER MURIELLE LIMA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16933 144TH RD
JAMAICA NY
11434-5929
US

IV. Provider business mailing address

10102 AVENUE L 1ST FLOOR
BROOKLYN NY
11236-4410
US

V. Phone/Fax

Practice location:
  • Phone: 718-978-0032
  • Fax:
Mailing address:
  • Phone: 718-844-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number321545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: