Provider Demographics
NPI:1316589898
Name:FAROUL, MARIE MONISHA (LPN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MONISHA
Last Name:FAROUL
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 1:105 HOWELLS RD APT C3
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6430
Mailing Address - Country:US
Mailing Address - Phone:347-455-5737
Mailing Address - Fax:
Practice Address - Street 1:105 HOWELLS RD APT C3
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6430
Practice Address - Country:US
Practice Address - Phone:347-455-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse