Provider Demographics
NPI:1326518838
Name:MARCELIN, MARIE DOMINIQUE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:DOMINIQUE
Last Name:MARCELIN
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 1:1543 NOSTRAND AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5138
Mailing Address - Country:US
Mailing Address - Phone:929-369-4369
Mailing Address - Fax:718-284-0146
Practice Address - Street 1:1543 NOSTRAND AVE APT 3C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5138
Practice Address - Country:US
Practice Address - Phone:929-369-4369
Practice Address - Fax:718-284-0146
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY468105-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse