Provider Demographics
NPI:1164134193
Name:ANDERSON, MARKIAH MONIQUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARKIAH
Middle Name:MONIQUE
Last Name:ANDERSON
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 1:97 CLINTON AVE APT D
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-2749
Mailing Address - Country:US
Mailing Address - Phone:518-334-0801
Mailing Address - Fax:
Practice Address - Street 1:97 CLINTON AVE APT D
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-2749
Practice Address - Country:US
Practice Address - Phone:518-334-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345326-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse