Provider Demographics
NPI:1164967493
Name:NORRIS, FATIMA DANAE (LPN)
Entity Type:Individual
Prefix:MS
First Name:FATIMA
Middle Name:DANAE
Last Name:NORRIS
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 1:1585 BEDFORD AVE
Mailing Address - Street 2:3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1389
Mailing Address - Country:US
Mailing Address - Phone:347-961-2438
Mailing Address - Fax:
Practice Address - Street 1:1585 BEDFORD AVE
Practice Address - Street 2:3C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1389
Practice Address - Country:US
Practice Address - Phone:347-961-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327487-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse