Provider Demographics
NPI:1043597966
Name:OUMRIM, MARYANN LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:LYNN
Last Name:OUMRIM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:46 DEVILS ROAD
Mailing Address - City:LAKE HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12752-0341
Mailing Address - Country:US
Mailing Address - Phone:845-932-8599
Mailing Address - Fax:
Practice Address - Street 1:252 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2178
Practice Address - Country:US
Practice Address - Phone:845-294-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278334-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse