Provider Demographics
NPI:1326231184
Name:TORRES, MARJORIE ANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:ANNE
Last Name:TORRES
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 1:18 NANTUCKET DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4321
Mailing Address - Country:US
Mailing Address - Phone:631-286-8641
Mailing Address - Fax:631-286-8641
Practice Address - Street 1:18 NANTUCKET DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4321
Practice Address - Country:US
Practice Address - Phone:631-286-8641
Practice Address - Fax:631-286-8641
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500580-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206164Medicaid