MEDICARE: MS. MARCIA SEMPLE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	267383	NY

General Provider Information

NPI Number	:	1619129962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA SEMPLE LPN

Provider Business Mailing Address
First Line	:	11118 174TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-4009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9715 64TH RD
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2250
Country	:	US
Telephone Number	:	718-459-5592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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