MEDICARE: MARYSE VERONICA JEAN-LOUIS RN, HN-C

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	163W00000X	Registered Nurse	RN9277487	FL

General Provider Information

NPI Number	:	1730654393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYSE VERONICA JEAN-LOUIS RN, HN-C

Provider Business Mailing Address
First Line	:	3660 NE 166TH ST APT 312
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-3820
Country	:	US
Telephone Number	:	678-777-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 NE 167TH ST STE 1016
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2448
Country	:	US
Telephone Number	:	305-783-9456
Fax Number	:

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

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	10/10/2018

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