Provider Demographics
NPI:1194225433
Name:MARRA, DEBORAH LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:MARRA
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 1:110 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1542
Mailing Address - Country:US
Mailing Address - Phone:585-546-7220
Mailing Address - Fax:
Practice Address - Street 1:110 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1542
Practice Address - Country:US
Practice Address - Phone:585-546-7220
Practice Address - Fax:585-456-1684
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302005164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse