Provider Demographics
NPI:1104198753
Name:RHABURN, MARILYN GERALDINE
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:GERALDINE
Last Name:RHABURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-2944
Mailing Address - Country:US
Mailing Address - Phone:718-974-1950
Mailing Address - Fax:
Practice Address - Street 1:744 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-2944
Practice Address - Country:US
Practice Address - Phone:718-974-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY498226163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse