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General NPI Number Information
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NPI Number | 1790926087
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Entity Type | Individual
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Provider Name | MARJORIE LAUREL HEADLEY LPN
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Gender | Female
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 4951 DIANTHA WAY
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City | BROOKSVILLE
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State | FL
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Zip | 34604-8283
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Country | US
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Telephone | 414-803-4986
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Fax |
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Provider Business Mailing Address
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Address Line | 2458 W LLOYD ST
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City | MILWAUKEE
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State | WI
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Zip | 53205-1048
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Country | US
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Telephone | 414-803-4986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 187915-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9668886
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License Number State | FL
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