Provider Demographics
NPI:1346585262
Name:PURNELL, MARNI SHANNON (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARNI
Middle Name:SHANNON
Last Name:PURNELL
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 1:12330 83RD AVE
Mailing Address - Street 2:APT 6A
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3450
Mailing Address - Country:US
Mailing Address - Phone:718-263-3708
Mailing Address - Fax:
Practice Address - Street 1:12330 83RD AVE
Practice Address - Street 2:APT 6A
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3450
Practice Address - Country:US
Practice Address - Phone:718-263-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312385164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse