Provider Demographics
NPI:1306220868
Name:LOUISGENE, MARIE CHARLENE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CHARLENE
Last Name:LOUISGENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ARLMONT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2903
Mailing Address - Country:US
Mailing Address - Phone:203-892-7008
Mailing Address - Fax:
Practice Address - Street 1:25 ARLMONT STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461
Practice Address - Country:US
Practice Address - Phone:203-278-9143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Yes126800000XDental ProvidersDental Assistant