Provider Demographics
NPI:1407424989
Name:MARDONES, CLAUDINE M
Entity Type:Individual
Prefix:MISS
First Name:CLAUDINE
Middle Name:M
Last Name:MARDONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLAUDINE
Other - Middle Name:M
Other - Last Name:GOBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:361 RONKONKOMA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5369
Mailing Address - Country:US
Mailing Address - Phone:631-672-4822
Mailing Address - Fax:
Practice Address - Street 1:361 RONKONKOMA AVE APT C
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-5369
Practice Address - Country:US
Practice Address - Phone:631-672-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339082164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse