Provider Demographics
NPI:1164840195
Name:CIAMBRA, MARISSA JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:JEAN
Last Name:CIAMBRA
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 1:121 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4726
Mailing Address - Country:US
Mailing Address - Phone:631-332-3809
Mailing Address - Fax:
Practice Address - Street 1:121 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4726
Practice Address - Country:US
Practice Address - Phone:631-332-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316786-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse