Provider Demographics
NPI:1326161688
Name:LABRANCHE, MARIE KESLENE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:KESLENE
Last Name:LABRANCHE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 THE HOLW N
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1520
Mailing Address - Country:US
Mailing Address - Phone:516-624-9639
Mailing Address - Fax:
Practice Address - Street 1:54 VIOLA DR
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3326
Practice Address - Country:US
Practice Address - Phone:516-676-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01031850Medicaid