Provider Demographics
NPI:1326561861
Name:TOUSSAINT, KATIAMARIE
Entity Type:Individual
Prefix:
First Name:KATIAMARIE
Middle Name:
Last Name:TOUSSAINT
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 1:123 LA BONNE VIE DR APT E
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4431
Mailing Address - Country:US
Mailing Address - Phone:631-569-5382
Mailing Address - Fax:
Practice Address - Street 1:123 LA BONNE VIE DR APT E
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4431
Practice Address - Country:US
Practice Address - Phone:631-569-5382
Practice Address - Fax:631-569-5382
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6269441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse