Provider Demographics
NPI:1235476169
Name:GUILLEN, MARLENE GIOVANNA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:GIOVANNA
Last Name:GUILLEN
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 1:421 48TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1918
Mailing Address - Country:US
Mailing Address - Phone:347-743-9505
Mailing Address - Fax:
Practice Address - Street 1:130 W TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5436
Practice Address - Country:US
Practice Address - Phone:718-583-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312373-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse